NICE to see You? To see you – not.

Diane Danzebrink has been pushing for answers to your questions around menopause. Based on heartfelt pleas from those of you struggling with menopause symptoms she has put your vital questions to the medical establishment – and after weeks and months of waiting, responses are starting to arrive.

Questions were asked of the General Medical Council (GMC), the Royal College of GPs, the UK professional body for general practitioners and to The National Institute for Health and Care Excellence (NICE), which provides national guidance and advice to improve health and social care.

The NICE response was judged “not very helpful, to be honest” by Di. Here’s her video diary thoughts on what they said.

Here are the questions DI asked on your behalf:

Good Morning. My name is Diane Danzebrink and I run Menopause Support which offers education, information, advice and support to women and their families who are struggling with the symptoms of menopause. I am regularly being told by women that their doctors are refusing to prescribe HRT. Some doctors say they don’t agree with it, others say they think it doesn’t work, some say it just delays symptoms, some say their practice does not prescribe it. I have heard of women incorrectly informed that they are not eligible as they suffer from migraines or smoke etc. I have also counselled women incorrectly prescribed (oestrogen only for a woman who still has her womb)

I realise that the guidelines set out very clearly to doctors what they should be doing but many are not following them and a shocking amount have never heard of them and certainly not read them. Please advise what rights a woman has when her doctor is refusing to prescribe hrt to her in situations similar to those described above. I realise of course that there are some medical conditions that would preclude hrt but I am referring to otherwise healthy women just hoping to ease menopause symptoms. Please also advise what can be done to increase the awareness and implementation of the guidelines amongst health care professionals.

I would be very happy to discuss any of the above either via telephone or in person and if there is anything that menopause support can be involved in to further the awareness I would, of course, be very happy to help.

I look forward to your reply.

Kind Regards , Diane Danzebrink www.menopausesupport.co.uk

And here’s the NICE response:

Dear Diane

Thank you for contacting the National Institute for Health and Care Excellence (NICE).

As you are aware we have published a guideline on menopause: diagnosis and management (NG23) and this guidelines covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause.

NICE has a number of work programmes, each producing guidance with a different remit and status in the NHS. The above guideline is a clinical guideline. Under this work programme, our role is to develop high quality guidance on the treatment of health conditions. However, whilst we publish a range of tools to assist Trusts to implement our guidance, our role does extend to monitoring its implementation or the care provided by individual NHS organisations. NHS organisations in England are expected to take NICE clinical guidelines into account when planning the delivery of care but they are advisory rather than regulatory and therefore there is no legal requirement for Trusts to follow the recommendations in this guidance. Instead, it is the Care Quality Commission (CQC) as the independent regulator of health and social care in England, which ultimately has responsibility for the regulation of NHS Trusts, which includes assessments of whether they comply with the recommendations in clinical guidelines.

We recommend that patients who are unhappy about the treatment or care they have received from the NHS (for example, if they were not able to access treatment recommended by NICE) should try and resolve the problem at a local level first, by talking to a member of their healthcare team. The next step is to make a complaint to the healthcare provider. The Patient Advice and Liaison Service (PALS) at the local NHS trust or clinical commissioning group will be able to offer advice on how to go about doing this. Contact details can be found on the NHS Choices website or via your hospital or GP surgery.

I hope this information has answered your question(s). Please tell us how we did by completing our short survey. It will only take you a couple of minutes.

Kind regards, Katy Summerscales, Communications Executive (Corporate Communications), National Institute for Health and Care Excellence Level 1A