Home HPV testing shows why choice matters in women’s healthcare
NHS England has begun rolling out at-home HPV self-testing to women who have fallen behind with cervical screening. Nearly four million women in England are not currently up to date, with embarrassment, lack of time and worries about discomfort among the reasons women do not attend. The new offer gives eligible women another option: taking a vaginal swab privately at home and returning it to the NHS, without first attending a cervical screening appointment. It responds to women who have struggled with the existing route by giving them more control over how they access screening. That principle has significance well beyond cervical cancer. Greater agency over how women receive care could be one practical way of helping to close the gender health gap.
The gender health gap is visible both in women’s health outcomes and in their experience of healthcare. Women in the UK live longer than men, but in 2022 to 2024 could expect to spend only 73% of their lives in good health, compared with 77% for men. England’s first Women’s Health Strategy also acknowledged that healthcare had historically been shaped by a “male as default” approach, affecting research, policy and the design of services. Its consultation found that 84% of respondents had experienced occasions when they or the woman they had in mind were not listened to by healthcare professionals, including when discussing treatment options. These problems have many causes. One of them is a health system that has too often expected women to fit the care on offer, with too little power to shape that care around what works for them.
Giving women more choice can make a difference. In a study of women receiving contraceptive care, consultations were structured to give women more opportunity to discuss their preferences and choose between contraceptive options. Ninety-five per cent rated the approach positively and, among women followed up six months later, the proportion who were very satisfied with their contraceptive method increased by 30%.
There is evidence that preference can matter to outcomes too. A review of 27 trials was designed specifically to test whether patients did better when they received the treatment they preferred. Across the studies, patients who received their preferred treatment had better clinical outcomes than those who did not. Giving women agency therefore has a practical purpose. The patient often knows which of the clinically appropriate options will work best for her, and giving her a meaningful say allows healthcare to reflect that.
This becomes particularly important when women’s preferences differ between communities, and part of the strength of at-home HPV testing is its ability to respond to those differences. Research in England found that 71% to 91% of South Asian women surveyed described cervical screening as embarrassing, compared with 28% of White British women. Women from Indian, Pakistani, Bangladeshi and African backgrounds were also more likely to worry about seeing a male doctor or nurse, at 15% to 26% compared with 9% of White British women.
Where there is only one way of receiving care, differences like these can become barriers. In the YouScreen trial in England, offering self-sampling increased the number of previous non-attenders being screened each month by 22%; 64% of those who responded were from minority ethnic groups and 60% lived in the two most deprived national quintiles. Giving women greater agency makes it easier for the same universal health service to work for a wider range of women.
The government’s proposed Patient Choice Charter creates an opportunity to extend that principle beyond cervical screening. Set out in the 10 Year Health Plan, the Charter is intended to give patients greater choice and control over their care. For women, that should include more say over the practical choices that can determine whether care works for them: who provides it, how it is delivered and, where appropriate, which clinically suitable option they receive. A preference for a female clinician during an intimate examination should be easy to record when booking. Alternatives in testing and treatment should be explained routinely, and self-referral and safe self-testing expanded where the evidence supports them.
Choice over where care happens matters too. The 10 Year Health Plan envisages more care being provided at home and through neighbourhood health centres, while the renewed Women’s Health Strategy plans for women’s health services to sit within this neighbourhood model. Together, these reforms provide an opportunity to make meaningful choice a more routine part of women’s healthcare, rather than something available only to those who know an alternative exists and feel confident enough to ask for it.
At the Health Equality Foundation, we believe greater agency should be part of how the NHS closes the gender health gap. That means designing services with women from the communities they are intended to serve, examining patient experience in ways that show where particular groups are still being poorly served, and building the choices women say matter into the way care is commissioned and delivered. The rollout of HPV self-sampling provides a clear example of what this can look like: women who did not use one route into screening are being given another. A more personalised NHS should apply that lesson much more widely. Giving women greater power over who provides their care, where they receive it and how it is delivered can help create a health service that works better for women whose needs have too often sat outside the norm.