Designing a Successful Menopause Support Strategy | Charlotte Andrews - Associate Director - NHS

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Brilliant, thank you. So, yes, I'm Charlotte Andrews, I'm currently Associate Director of Learning and Wellbeing, so I look after wellbeing leads, occupational health, and training, and this is across two trusts.

So, I look after a Foundation Trust and also Community Trust, so two very different challenges. I've gone for a very different technique and slides today. The reason being that it got to Friday last week and I had an email saying slides due on Friday, it's on the to-do list, so I've kind of thrown it out the window, which is totally out of my comfort zone today, so I'm feeling a little bit awkward.

Instead of having a lot of data and normal EMC reports, we're just going to go with some basics, and I'm literally just going to talk you through how over the last sort of year and a half, we've developed what I think is a successful mentor support strategy.

Okay, so most of you are going to know the basics anyway because menopause is a really big thing in the UK, just the world, but specifically in the NHS. So as we know, there are 3.5 million women over 50 in the workplace currently. That is a huge amount of women, and out of that, 1.3 million working in the NHS alone. The average age for entering menopause is 51; however, it can be a lot younger. And just for reference, across both of our organisations, 78% of our staff are female, and out of those 78%, 60% are within the perimenopause menopause age.

Perimenopause starts as early as in your 30s. Perimenopause comes with a range of symptoms; a lot of people don't necessarily realise that they are in those stages. They might put it down to stress at work, tiredness, problems with their diet, problems with their family life, their kids are stressing them out, but six out of every ten women in perimenopause and menopause experience symptoms, and that's why this strategy is so important. Because in the NHS, we are struggling with our workforce, we're struggling with retention, we're struggling with our funding, and we need to be able to make sure that our staff are supported to stay at work and be able to carry out their job feeling that they are well enough to do so.

Okay, so let's talk a little bit about the journey. I started at Kingston about two and a half years ago, and I remember my boss, my CPO, day one said to me, "I've put a meeting in, lovely, here's your induction, and there's a meeting, and I'm going to chuck you on a task and finish group, and it's all about the menopause." And I was 42 at the time, and I kind of knew a little bit about menopause, you know, had a mum, I've got kids, kind of know how it works, but I thought, okay, don't really know what we're going to do, there might be a quick meeting, and that will be it, done.

So I went onto it and learned that we were going to cover training, we were going to look at how we were going to improve uniforms, we were going to look at the environment for staff, we were going to focus on conversations, how to make it normal, all of these amazing things that they wanted to accomplish in the task, and I came away, my boss, my new manager, that I needed to impress and said, "What are you going to do next?" I was like, "I don't really know, don't mean to know, uh, don't know, need to go and learn about it." So I did a very quick crash course, through Peppy, who supported me, gave with some slides, and said, "This is what menopause is about, where you go." So I chatted to a couple of colleagues who are slightly older than myself, uh, who have actually experienced menopause, and sort of said, "What do you think we should do?" And they said, "Well, lots of places do support groups, why don't we just give it a go?".

So bravely, I thought, okay, we'll just put it in a diary, and we whacked it in that old Outlook, and I titled it, menopause support group, and I sent it out to all of the women aged 40 and then thought, nobody knows who the hell I am, so nobody's actually going to reply. Got to about day 45, and it was the day of the support group, and I remember it well, it was 9:30 in the diary, it was on Teams, and Teams never works well if you're in the NHS, and, I logged on, and I got one of my colleagues to come on with me because I thought, you know, at least that be two, and when I logged on, there were 13 other women already on the call, at which point I then had a massive panic because I thought I don't actually know that much apart from the small PowerPoint slides that somebody gave me from Peppy about menopause, which was literally the a-z guide, and basically opened it up and just said, "Okay, this is who I am, this is what we want to do, and I've created a group, and it's for you, and you might want to talk, and you might not, not really sure how confident people are chatting about their menopause experience."

What followed was just over an hour of women sharing their story with no judgment and no holds barred, and when I say no holds barred, I had women telling me about how they had wet themselves in the supermarket, I had women telling me about how they had had to feign a different sickness, they'd rather say that they had vomiting and diarrhoea profusely over five days than tell their manager that they're in menopause.

These women were so keen to share their story, and we finished the group, like, kind of thought, I've opened a bit of a Pandora's Box because I've got all these women that are desperate to talk about it, I don't really know what I'm talking about, apart from my powerpoint a-z, "What are we actually going to do?"

As an organisation who's got a very limited budget, as we all know, there's no health and well-being budget anywhere, and whilst we're making a really big thing about menopause in the NHS, there was no money that actually came with that, what is it that we're actually going to do? And then, where did we begin?

So I knew that we needed to do things with uniforms, we needed to provide the support, but how are we actually going to achieve it?

So this is where the strategy came in, about three months into the job, I then went on to another task and finished pilot group with NHS England, and some of you might have been on it, the Health and Wellbeing framework 2021-22 that came out. So Kingston and HRCS passed this, and for those of you that know, a lot of us usually have four or five pillars for our wellbeing, and under the new framework, there's seven pillars, so great, perfect opportunity, we're going to have to do loads of more work now, we're going to have to have a new health and marriage strategy, we're going to have to have a new policy across both organisations, so let's make this a little bit more menopause-friendly and see what we can do to actually use all of the resources we have in place.

So first things first, we had to go on the intranet, and anyone in the NHS in the room knows how great the intranet is, it's obviously really responsive, really modern, touch of a finger, can update it, you don't need a whole power telling you how you're going to update it and it still doesn't work, and it comes to then, oh, I don't know, I don't know. So, we thought, actually, I know how to build a website, so we'll just knock a website together, and in true style, I thought, well, I won't do a business case, it's fine, you know, we'll just do one and see what happens. So we spent about four weeks, and we built the first health and wellbeing website. It's one of the first NHS ones to have their own independent wellbeing website, and it was for the purpose of menopause.

The second purpose was to actually be able to embed that health and wellbeing framework and allow us to be able to update things in real-time for our staff and to actually take it, you know, the 21st century, and be able to put things on there.

So we created that, and then we thought, okay, well, we've got a website, we've got metrics, that website has been around a year now, we've had just over 36,000 visits to it, so we know it's working, but how do we actually now incorporate that into everything else we do? How do I now write a strategy that focuses on all of health and wellbeing, and particularly the menopause?

I thought again, I'm not the expert, so listen and listen again. We went out to our staff, and staff are sick of surveys, we have staff surveys, we have pulse surveys, we have surveys about what to have in the canteen, um, and I thought, well, we'll do another survey because why not, that's what we do, and we had an unprecedented response. We actually ended up running 12 focus groups over two months just with staff that wanted to talk, and it wasn't just female staff, there were male staff as well because their wives were affected, their mums were affected, had a colleague that had been affected by it, they wanted to learn more, they wanted to share their ideas.

So we took all that feedback, and we sat there, and we thought, okay, so we've got staff that are wanting to share their experiences, we've got staff who are uneducated, a bit like myself, we've got staff, who know a little bit but might not know the right thing, we've got no money, and we've got a team of resources all doing different things, we've got a psychologist, a psychiatrist, a staff physio, an OH team.

So then we thought, we'll just start doing some lunch and learns, get a bit more, get some guest speakers to support group, so it's not me doing all the talking, um, and I invited a lady called Victoria, Victoria lives locally to me, I'm actually from Norwich, and I found her on LinkedIn, top tip if you ever want guest speakers for free, LinkedIn is the best place to, I think that's where we headed up, best place to go, great, yeah, so most of ours come from there, and they don't charge something which is great for the NHS. But I met this Victoria, and she was doing a bit of work, she was a specialist menopause nurse, so she came along, and she did two lunch and learn, so we're fully booked out, never happens, doesn't matter what time, you know, you do a wellbeing session in the NHS, you do it at 8, they want it at 12, you do it at 12, they want it at five, you're never going to make everyone happy, but they turned up, and she was brilliant, and after that, we kind of had a coffee, and I was like, well, you know, we're doing all this, and I'm writing a strategy, and I've got this flashy website, that's probably got some spelling mistakes on it, and don't know what to do next, what I'd really love is to be able to actually get some of these people in front of a specialist because the GPs, a lot of GPs, I'm mindful that there is a GP in the room now as I am saying this, some GPs don't have as much menopause training, let's put it out there, and that's feedback we have from our staff, and they also can't get appointments sometimes.

So we decided to set up a clinic with Victoria, we thought we'd run it a bit like a GP, and again, we'd see if anyone actually wanted to attend the clinic.

So we set it up, we agreed she had, some frameworks, we created some referral forms, we decided that the referrals would be direct referrals from staff, they come into our staff wellbeing support hub, everything will be confidential because she's a private contractor, I don't need to know the ins and outs, and then as soon as, okay, we just sent all the paperwork off to her, and then that would be it.

So we opened up, and we put it in our global, and I think we put it in on a Tuesday, the first clinic on the following Monday, and she had 12 slots, all 12 slots from that first morning.

We did it again, because I was, I was paying peanuts, I'll be honest, and, that's all we had, and again, all the slots sold out. She's been in post, we've just completed a year, she manages to see 12 staff every single week, and she has a three-month waiting list at the moment, and they are all first-time staff, they're not even the revisits, the demand is huge.

We have 5,000 staff across both organisations, we can't keep up with the demand. The thing that we do with the menopause nurse is we actually look to see how we can triangulate everything using the resources.

So talk about triangulation. So Victoria doesn't operate in silo, as I said, I've got a psychologist, a psychiatrist, a physio, a pastoral team, they're all out there. So what we ensure is that if a member of staff has or needs an appointment with Victoria, she will have that appointment, Victoria will then do a referral back to one of the specialists.

So if you go to your GP at the moment, or you go to a sexual health clinic to talk about menopause, and you might say you're suffering, you feel that you're having a lot of muscle pain, muscle aches, it's causing you issues sleeping at the moment, you might probably have a waiting time of about 16 to 24 weeks.

Through Victoria, we're able to make an appointment the same week with one of our staff internally and get them seen. The exact same is with the psychologist, so we're able to provide psychology help, you can provide counselling as well, accessing some of our counselling, and we've, me in with our EAP.

We're also able to do direct referrals from Victoria through to occupational health and vice versa. So we're able to provide that whole wraparound holistic care piece, all of this in turn is making staff's lives just that little bit easier, and we are now seeing that there is a reduction in the sickness of our staff.

The reason we're able to see that now is because we just started recording it on ESR, NHS came out about a year and a half ago with a really handy user guide, nobody did it, I don't know, did anyone in here start to record it on ESR, tried, yeah, really handy user guide. So we're now recording it on ESR because we actually want to be able to see the impact, and we want to see how many staff are actually, because this is only the tip of the iceberg.

We are taking a top-level down, bottom-level up approach, we are historically male-heavy board of both organisations, um, and of course, our consultants as well, um, and they've just had to get comfortable with it at the end of the day, you know, they've all been born, they've all had a mother at some point, so, you know, that mother will have hopefully gone through menopause at some point, it shouldn't be a taboo subject, our chief exec talks about it in weekly briefings, my CPO is a massive advocate, he sits on the menopause support group sometimes, he's curious because his partner has reached that stage in life. That has been a real game changer for us, and from that, we've now had to start to look at other areas.

So things we're now doing for the future, train, train, and train again. We've developed a new training academy for health and wellbeing across both organisations, and fundamentals to that is the elements about menopause. We've paid people before to come on courses, you know, we've had all of those things, they're not sustainable, it's a tick box exercise, and the staff go away, forget about it, we're all knackered and stressed, and we've got a lot on our plates, so we now have training so they can refer to at any time if they have that difficult challenging conversation with a member of staff where they feel uncomfortable, they're able to access that training at the drop of a hat, refresh their memory, they can go through it with that staff member.

We're reaching further, it's not just the menopause we're looking at, fibromyalgia, and other areas, anything that impacts, and as I said, looking at male menopause and how we support staff, we're running men's health clinics to be able to start those conversations because a lot of our male staff aren't very confident in talking about themselves, funnily enough, as we said, it's not just for women.

But the one thing we want to do is make this the new norm, we know that it's never going to go away, there's always going to be menopause, and we just need to know how to sit and be comfortable with it. The only bit of information I put is our staff wellbeing website address, feel free to have a look at it. As I said, it was something we put together, total cost, I think, was about £89 it cost me to build it. I've said this 36,000 hits, totally independent, it has a booking facility on it, we put all of our free classes, our events, but more importantly, staff can access it when they're at home, on the move, because you can't access the internet when you're off-site.

Thank you very much. Any questions?