On International Women’s Day 2022 we launched Ireland’s first ever Women’s Health Action Plan. In the four years since, healthcare workers have been transforming care – new services, quicker access, integrated pathways, elimination of cost barriers. While there is still much to do, vital and far-reaching improvements have been made.
The specifics for the UK and the NHS – the particular strengths and weaknesses in services and outcomes – are different to those in Ireland. However, women’s healthcare is also being prioritised in the UK – important steps have been taken by the new government and a renewed Women’s Health Strategy is in development. In the spirit of International Women’s Day 2026, I thought it might be useful to reflect on the approach taken in Ireland that made it one of the most impactful areas of change in recent years.
In case you’re reaching for the AI summary, here’s the really short version…First – listen carefully. Put service users front and centre to really understand the services they want. Second – respond holistically. Consider the full life cycle and both clinical and cultural changes needed. Third – foster innovation. Task and support clinicians to find new and better ways of providing care and improving outcomes. Fourth – deliver clearly and consistently. Design and implement a plan that is funded, focused, easy to communicate and provides early wins.
The scale of the challenge
When I was appointed Minister for Health in 2020, too many aspects of women’s health services were simply not fit for purpose, in spite of the best efforts of a highly skilled and dedicated workforce. The National Maternity Strategy was gathering dust. Midwifery-led care was not available for many, perinatal services were scarce, breastfeeding supports were geographically patchy and the physical infrastructure for maternity care was, in most cases, creaking at the seams. Not only were menopause services difficult to find, even talking about menopause was taboo. Endometriosis went largely undiagnosed. Hospital gynaecology waiting times were growing year on year. Fertility services were patchy and IVF was too expensive for many. Long-acting reversible contraception was expensive. Active ageing supports were few and far between…the list goes on. Clinicians working in women’s healthcare reported being squeezed out by other service areas. For example, they would see gynaecology theatre lists being cancelled before other services in cases where emergency capacity was needed.
Given the scale of the challenges, steady incremental change was not an option – chances are things would have slipped back, in time, to their deeply unsatisfactory equilibrium. Instead, I announced (a little grandiosely for the Irish psyche) that we needed a revolution in women’s healthcare. Others can judge how the ‘revolution’ is going – but a few things are clear…Our healthcare workers delivered in a few years what would normally take decades. Clinicians across the country have spoken of transformative improvements for service users. Women’s healthcare is no longer a poor relation to other services and is no longer taboo. Progress in continuing, focusing on areas that need urgent attention like access times for specialist endometriosis care. Here are some of the reasons why our healthcare workers were able to achieve so much is just a few years.
Listening carefully
A Women’s Health Taskforce, comprising clinicians, representative bodies and service users, conducted a ‘Radical Listening Exercise’, hearing from hundreds of women across the country. The work provided invaluable, and sometimes sobering, insights into the strengths and challenges of the models of care and cultures of care. Central themes included the need for health information and education, respect, time with clinicians, joined up care, the role of GPs, gaps in services and outreach to marginalised communities.
This formed the bedrock of the 2022 Action Plan. It was the deepest level of co-design of any policy launched in my five years in office and was central to the level of support the work garnered from clinicians and service users. By the time we launched the second action plan, in 2024, nearly all initial targets had been exceeded. It sounds blindingly obvious, but is the exception rather than the rule – ask people what health services matter most to them, then provide those services.
Responding holistically
A whole life cycle approach was taken. This included a strong emphasis on prevention and wellbeing, including expanding vaccinations and screening. Care was to be provided as close to service users as possible – home, GP, specialist community team, hospital – in that order. The listening exercise would become a regular activity, feeding back to the centre so gaps and improvements could be identified and actioned.
Fostering innovation
One of the most underutilised forces of Ireland’s national health service is the raw innovative power of our clinicians. An exhausting array of barriers sits in their way. Much as was done during Covid, the message from clinical, administrative and political leaders was clear – make the changes you need to make, where you are stopped, escalate immediately and those barriers will be dealt with. New models of care were rolled out in gynaecology – moving in some cases from multiple visits over several years to one visit in a matter of weeks. Advance Nurse and Midwifery Practitioners were deployed to a myriad of high-value roles. The free contraception scheme was leveraged to start broad, early-stage health conversations between young women and their GPs. Free IVF was introduced for eligible couples, followed by free HRT. Specialist clinics were set up for menopause and endometriosis. GPs received a range of new training and reference guides. New maternity options, supports and facilities were rolled out including for birth, bereavement, perinatal and post-natal care. A new national maternity hospital was commissioned. A national fertility service was rolled out. Billboards, newspapers and online platforms hosted a national menopause awareness campaign. A plan was launched (and is on target) for the elimination of cervical cancer. Eating disorder teams were expanded. Active aging initiatives were kicked off for cardiovascular and bone density health.
Delivering with clarity and consistency
We took a deliberate decision to launch 2-year action plans rather than the longer-term strategies sometimes required. It was clear what needed to be done, by who, by when, and what outcomes were required. We were blessed with strong leadership from department officials and HSE teams. Progress could be seen quickly and repeatedly. We emphasised the priority of these plans through the formal health planning processes and through political dialogue. It’s important to acknowledge the positive constructive role played by so many government and opposition politicians and parties – without a doubt that broad political support made it easier for all involved to make as much progress as possible.
Up front funding was needed – by 2024 I had increased the annual recurring investment by €140m. But the financial returns over the medium term are far in excess of this, when what matters most – better health outcomes, is considered. Disease prevalence falls, chronic condition rates fall, surgical complexity falls, emergency presentations fall, elective acute demand falls, maternity outcomes improve, healthy aging improves with a corresponding reduction in frailty, marginalised communities begin to get preventative and proactive care. The experience for service users and healthcare workers improves.
Looking back, it’s clear that we took this task on differently. The radical listening exercise was a level beyond other stakeholder engagement. The two 2-year action plans were some of the most focused plans we developed. We invested heavily in building a coalition in the HSE, civil society and parliament. We removed obstacles quickly for clinicians. The results so far – while still a work in progress – show the hugely positive impact this approach had. I hope it’s something we can build on.
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About the authors
Stephen Donnelly
Stephen Donnelly served as Ireland’s Minister for Health from 2020 to 2025, where he led comprehensive healthcare transformation including in women’s health services. He is now Partner at Carnall Farrar, advising health systems across the UK, Europe, and the Middle East on transformation, strategy, productivity, and integrated care delivery.
