The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I congratulate the hon. Member for West Ham (Ms Brown) on securing this debate. I thank her for all her hard work. I am very sorry that she has been speaking about this issue for nine years and is still having to share some of the stories and experiences of women who have contacted her, whether that is Jane, who was unaware of the potential for pain when having such a procedure—women being investigated for endometriosis often wait eight to 10 years to get a diagnosis, so if there is an offer of a procedure to find the cause of their problems, of course they will grab it and not necessarily ask questions about what is involved; or Sandy, who got no information on pain relief at all, or Penny. Penny was warned by the nurse—often nurses are attuned to these things—and was worried about what the outcomes were, but went ahead with the procedure. These are shocking tales that should not be happening in this day and age. I appreciate everything that the hon. Lady says, and I offer that I will be happy to work with her on this issue.
As Members will be aware, hysteroscopy is an essential tool to get to the bottom of many complaints. Whether that is cancer, endometriosis, vaginal bleeding or pelvic pain, it is a necessary test. While other tests can be used, they do not necessarily get to the level of clinical detail that a hysteroscopy can provide for clinicians. It is therefore important that the test is available for women, but in a way that does not create the problems we have heard about this evening.
Many women can have the procedure as out-patients in 10 to 15 minutes and it can be relatively painless, but many women, as we have heard today, experience great pain, which puts them off from coming back if they need further procedures, as the hon. Lady has said. If they share that story with other women they know, it can put them off from coming forward, too.
Unfortunately the NHS does not collect data on the number of women who experience pain during a hysteroscopy or the women who fail to have the hysteroscopy and then need to have either a general anaesthetic or further anaesthetic later on. I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of women are affected and have reported severe pain, and frankly that is not good enough. I welcome that NHS England will be meeting the campaign group on 4 February. I look forward to hearing the outcome of that meeting, and I will be following up any recommendations after that.
The hon. Lady is right that for many procedures a man would undertake, anaesthetic is probably routinely provided or offered. We need to ensure that the same applies to those procedures that women have to go through.
There are guidelines in place, and I spoke only last week to the president of the Royal College of Obstetricians and Gynaecologists, because I knew this debate was coming up. Those guidelines were published back in 2011, and they need updating. The guidelines focus on minimising pain and optimising the woman’s experience, as well as making specific recommendations on how to reduce pain, but as the hon. Lady said, we do not have the information to know who is and is not following those guidelines. We are therefore not in a position to say whether, if those guidelines were followed, many women would not experience pain, and that is the difficulty we have. The data is therefore crucial.
In the last debate that the hon. Lady secured on this issue, which I think was in September 2020, my predecessor, the right hon. Member for Mid Bedfordshire (Ms Dorries), informed the House that to ensure the recommendations were robust and up to date, the royal college would be producing a second edition, in which it will assess whether the current guidelines are effective and are being used. The second edition is being jointly developed with the British Society for Gynaecological Endoscopy, and I am assured that patients’ voices will be at the heart of its development. The royal college has informed me that good progress is being made, and that it will have the updated guidelines by next year.
Maria Caulfield
I said to the president that I would follow up after the debate, so I can certainly make that request.
The royal college has also said that it is producing a good practice paper specifically on pain relief and how informed decisions should be made, particularly in out-patient hysteroscopy procedures. It is going through the peer review process next month and will be published shortly afterwards. Once it is published, I would be very keen to hear from campaign representatives about whether they feel that those guidelines would make a difference to them in a practical session.
It is crucial that women who are offered a hysteroscopy are given the information they need to make an informed decision, given that they have sometimes waited a long time for the appointment and that serious clinical conditions can be diagnosed from it. That should include information about potential pain, options for pain management and alternative procedures that could be used.
The Department and NHS England recommend that, as part of good practice, the royal college’s patient information leaflet, which was published in 2018, should be provided to patients to aid decision making. I think that should be provided in advance of the appointment, because it is often hard for someone to take in all that information in the midst of a consultation. Again, I would be interested to hear from the campaign whether that is happening in practice.
The House will also be interested to learn that the British Society for Gynaecological Endoscopy recently published a statement to clarify that from the outset women should be offered
“the choice of having the procedure performed as a day case…under general or regional anaesthetic”.
It further asserts that the procedure should be stopped immediately if a woman experiences pain.
I encourage any woman offered a hysteroscopy to read those valuable resources along with any additional resources provided by their clinician. I agree with the hon. Lady that women often do not understand what a hysteroscopy is or what is involved, and debates such as this highlight how important the procedure is, the options around pain relief and the different anaesthetics available.
The hon. Lady touched on the tariff. Previously, there was a different rate of payment for hysteroscopies carried out in an out-patient setting compared with in-patient procedures. I recognise that that is a concern for many hon. Members on both sides of the House because of how it affects patient choice and the choices that are offered to them. In the last debate on the topic, my predecessor announced a statutory consultation. I am pleased to say that as of 1 April, hysteroscopy out-patient procedures will no longer attract a higher tariff than elective procedures as an in-patient day case. That will hopefully make a difference to the choices offered to women.
Ms Brown
That is absolutely true and we are delighted about that; I welcomed it in my speech. The problem that we now have is that if a hospital offers an anaesthetic, it does not get compensated for the resource that it has used. We need to go one step further to ensure that there are no incentives for not offering women proper anaesthetic.
Maria Caulfield
I completely agree with the hon. Lady. She made a point about having the data to see how many hysteroscopies fail and whether that money could be better spent on offering an anaesthetic up front to many women. I do not have an answer to that, but it would be interesting to look at that information.
Alongside clinical guidelines and access to high-quality patient information, I stress the importance of the voices of patients, which are critical at every stage of the treatment pathway. Decisions should always be discussed and shared between clinician and patient. The Government are committed to ensuring that the voices of women in particular are more central in the healthcare system.
The women’s health strategy has been touched on several times. We have also taken key learnings from reports such as the Cumberlege review, where women were talking for a long time about the issues that they faced before anyone truly listened. We need to improve that so we are not learning from such incidents after nine years of raising them on the Floor of the House. The women’s health strategy will include gynae issues such as endometriosis and polycystic ovary disease, which are conditions that do need a hysteroscopy, so I am pretty confident that we will cover that in the strategy. We will also have a women’s health ambassador—they will be appointed in the coming weeks; applications are almost closed—with whom I will meet. I want them to lead on these issues, where they can be a real voice for patients, do a deep dive into what is happening at the coalface and speak up for women if it is not working. We have guidelines, but we do not know whether they are being used in clinical practice. From what the hon. Lady says, it sounds like there are clearly issues that need to be addressed.
I reassure the hon. Lady that I am happy to work with her on this issue. Improving the tariffs is one thing, but there are still women who are not getting the information that they need to make informed decisions about pain relief and anaesthetic that could be available. I welcome the new information from the Royal College of Obstetricians and Gynaecologists on pain relief specifically for this procedure, which will be out next month, and I will feed back to it on updating the guidelines to ensure that patients are involved in the process.
I thank the hon. Lady for raising this important matter. I hope that we have raised its profile and that women are more aware of their options. When they go to that clinic appointment, they can ask for pain relief, they can have it as an in-patient, and they do not need to have it right there, right then. I look forward to continuing to work with her and all Members across the House to ensure that women are offered a hysteroscopy and can access the information they need and the care they deserve.
Madam Deputy Speaker (Dame Eleanor Laing)
Genuinely, thank you.
Question put and agreed to.