Endometriosis centres in Wales 'at risk of closure', gynaecologists warn

Specialist endometriosis centres in Wales are in jeopardy unless a national service is commissioned, according to gynaecologists who addressed a cross-party Senedd group on women's health. Cardiff and Vale health board has added its specialist centre to its risk register, warning that changes introduced by the British Society for Gynaecological Endoscopy (BSGE) could lead to its closure unless accreditation criteria are met. Clinicians say the pressure has been worsened by funding differences between England and Wales, and that failing to meet the requirements could mean downgraded services, a loss of skilled staff and more patients sent to England for treatment.

Kelly O'Shea, 32, who lives with chronic pain, said she paid £20,000 for the endometriosis treatment she needed out of frustration and desperation. She described daily pain lasting about three and a half years, with symptoms that began in her teens, and said her condition also affects her bowel, meaning she requires bowel and bladder specialists alongside endometriosis surgeons. After her most recent operation she was woken 45 minutes later to be told a bowel surgeon had not been available, so her endometriosis was left untouched; BBC Wales also spoke to another woman whose surgery was stopped elsewhere in Wales for the same reason. On a separate occasion, her surgery was cut short because the theatre was needed for an urgent case, and she said a transfer to Bristol was discussed before she was told another specialist centre in Wales would treat her, with a wait of up to two years depending on clinical need.

Lutfi Shamsuddin, one of the endometriosis surgeons at the Cardiff and Vale centre, told the meeting that the difficulties centre on allocating dedicated time for a multi-disciplinary team and ensuring surgeons carry out a minimum number of operations each year. Limited theatre access, he said, could leave individual surgeons unable to reach the volume of work required for BSGE accreditation, which demands named gynaecologists, specialist nurses, colorectal surgeons, urologists and radiologists with time set aside in their rotas at least six times a year. He said his own centre depended on the goodwill of a radiologist or urologist when needed rather than having those roles planned into the service.

It is estimated that about one in 10 women have endometriosis, and Shamsuddin said roughly 60% of patients can be managed by GPs in the community while 40% are referred to hospital gynaecology teams. Cases of deep infiltrating endometriosis, which affects organs such as the bladder and bowel, are referred in south Wales to one of two BSGE-accredited centres, while cases in north Wales go to hospitals in Liverpool or Chester. Cardiff and Vale also considers referrals from Cwm Taf Morgannwg and Swansea Bay receives referrals from Hywel Dda, while Aneurin Bevan is understood to be seeking accreditation and will consider referrals from Powys.

Abigail Holmes, clinical board director for women and children at Cardiff and Vale, told the meeting the board was working hard to prevent the service collapsing and said the only way it could survive was as a nationally commissioned service through NHS Wales' joint commissioning committee (JCC). The meeting heard that endometriosis services were discussed in June 2024 as a possible area for the JCC to commission, but no new investment was made available for 2026-27 so national services were not established; a spokesperson said responsibility remains with individual health boards. A petition over the future of the Cardiff and Vale centre has passed 11,000 signatures, and the board's executive medical director, David Fluck, said the service is core-funded and that it is actively working towards reaccreditation.

Delyth Jewell, the deputy minister for women's health in Wales, said she had been assured by Cardiff and Vale chair Kirsty Williams that the necessary steps were being taken, and that everyone agreed the current arrangement was not sustainable. She said she wanted to look at regional or national options so that services do not rely on the goodwill of individual health boards, adding that women already wait too long for endometriosis symptoms to be spotted. The Royal College of Obstetricians and Gynaecologists has echoed calls for the Welsh government to commit to sustainable resourcing of gynaecology services, including adequate workforce numbers, training and facilities, while Swansea Bay University Health Board, which has not placed its service on a risk register, also faces challenges around theatre capacity, workforce and multidisciplinary support.