Christmas Adjournment

Bob Stewart Excerpts

Thursday 19th December 2013 Commons Chamber

[Mr Amess]

The hon. Gentleman and I celebrated West Ham beating Tottenham 2-1 last night and I absolutely agree with him. I hope that a number of us will persuade the Government to support a new crossing.

The nice thing about cars running on gases is that they offer the motorist a cheaper and cleaner alternative. The autumn statement contained a 10-year pledge to keep stable the advantage of certain road fuel gases over conventional fuels. That is all to the good, but the road fuel gases that are being given that boost are used not in ordinary vehicles, but only in heavier or commercial vehicles. The only fuel to receive a knock in the statement was autogas—or liquefied petroleum gas—which is another road fuel gas used by 160,000 British motorists, so they have been put on the trajectory of a gradually reducing benefit from running cleaner cars. It seems an oversight to discriminate in favour of some fuel gases, so I hope the Treasury will look at that issue.

The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) is the secretary of the all-party group on fire safety and rescue and I am its chairman. He and I know that it is becoming increasingly apparent that we are not learning many lessons from serious fire incidents. If we look at the causes of major incidents over the past few decades, we will see that there are many common features and similarities. One example is the 2009 Lakanal House tower block fire, in which six people were killed and 20 injured. Many of the causes of that fire, as well as other, more recent fires, were the same as the Summerland fire 40 years ago. The Summerland inquiry recommended that architectural training should include a much extended study of fire protection and precautions. Yet 40 years later, what on earth has happened? I believe that many lives are being lost unnecessarily because we are not implementing that advice. I hope the Government will do something about it.

I am also worried about the Disclosure and Barring Service, previously known as the Criminal Records Bureau. A number of my constituents have had issues with it and one constituent in particular—a young man with Asperger’s—is finding it very hard to find employment because of it. A DBS certificate is now needed before people can apply for many jobs, including in schools and even cleaning positions, but my constituent is not able to obtain such a certificate, because it has to go through a recognised organisation. Given that the certificate is required before people can start jobs, my constituent is in a very difficult position.

[Bob Stewart (Beckenham) (Con)]

Does the new system forbid me from taking my children and other children to a cricket match when it is a school event, or has that silliness been sorted?

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[Jeremy Lefroy (Stafford) (Con)]

It is a great honour to follow the hon. Member for Falkirk (Eric Joyce). If he wishes, I invite him to my constituency, because South Staffordshire and Shropshire mental health care trust has an excellent unit dealing precisely with eating disorders. I had the pleasure of visiting it a few months ago, at the invitation of Sarah Robertson, a constituent of mine. He is most welcome to come and see the excellent work it does and find out more about it.

I wish to remember the men and women of 3 Mercian who are currently serving in Afghanistan. It is one of the regiments due to be disbanded, but I am glad that the name of the Staffords will be remembered. As my hon. Friend the Member for Beckenham (Bob Stewart) will know, it will be combined—we hope—with the names of the Cheshires and the Sherwood Foresters.

[Bob Stewart]

It is definite that the Staffordshire regiment will live on in the Mercian regiment. It must do. It is a great regiment. It will combine with the Cheshires and the Worcestershire and Sherwood Foresters. From my point of view, as an ex-Cheshire officer, we will get a huge number of Victoria Crosses when the Staffords join us; my regiment only has two.

[Jeremy Lefroy]

I am most grateful to my hon. Friend. We all share his sentiments, and our thoughts and prayers are with 3 Mercian and the other regiments and units serving in Afghanistan, including the tactical supply wing of the RAF, which is also based in my constituency.

I want to dwell for a moment on the report of the trust special administrators on the Mid Staffordshire NHS Foundation Trust, which came out yesterday. There are a number of good things in the report. Within the remit they were given—I think that that will need to be considered by this House because it needs quite a lot of change—they have done some good things. Those include recommending a merger of the University Hospital of North Staffordshire with the Stafford element of the Mid Staffordshire NHS Foundation Trust. They have also recommended that Cannock hospital goes to the Royal Wolverhampton Hospitals Trust. For Stafford, that is a good thing. We will become part of a large university hospital trust and be able to share services across a wider area. In addition to the excellent staff that we already have, we will be able to attract high-quality staff from across the country.

We are also retaining our accident and emergency department. At the moment, it is open for only 14 hours a day, but that is better than the nothing that was proposed earlier this year. However, I still believe that we need a 24/7 A and E department. Perhaps our use of the current department will reveal the need for an increase in hours, but at least we have retained the department and we can build on it in the future.

We have also retained acute services. At the start of the year, it was thought that Stafford would become a community hospital—not an acute hospital. I am glad to say that those fears have not been realised. The recommendations also include, for the first time, provision for a frail elderly unit, which is incredibly important as it builds on the work of the Cure the NHS group, founded by Julie Bailey, and the Francis report that came out as a result of that. I hope it will be a beacon for the care of elderly people across the country. It will show that in Stafford we can do such things to the highest standards. We will also have a large range of other services. The trust special administrators have said that 90% or more of current attendees at Stafford and Cannock will be able to continue to use those services. Cannock hospital has also been retained. In fact, more work will go on at Cannock, 60% of which has been unused for many years. I welcome that, as does my hon. Friend the Member for Cannock Chase (Mr Burley).

A lot of good things are going on in Stafford, and I welcome that. However—and this is a big however—there are things that I oppose and will continue to oppose, the most important of which revolves around paediatric services. Yes, there will be a paediatric assessment unit, but it will be linked with A and E and, therefore, open for only 14 hours a day. That means that children who get sick overnight will have to travel 20 or more miles to the nearest unit. That is not acceptable for my constituents or indeed for the constituents of surrounding constituencies. In addition, it will not be a consultant-led paediatric unit, and it will have no in-patient beds for children. That is a problem for children who turn up at night with serious illnesses, or perhaps a very high temperature. Their parents will be extremely worried and will want their child to be taken in and observed for perhaps a day or two before they return home. If the child’s condition is more serious, they will want them sent to a major unit such as in Stoke or Birmingham.

Provision for those who need in-patient child and adolescent mental health services in Staffordshire—indeed, throughout the country—is not nearly sufficient. Our general hospital in Stafford takes in a number of such young people, some of whom are suicidal. It should not have to do that, but it takes them in because there is nowhere else for them to go. I do not believe that the administrators’ proposals take that into account, although the issue was raised in the consultation.

The original proposals said that no women could give birth in Stafford, unless they were having a home delivery, but I am glad to say that the administrators have listened to the people and have recommended that we should have a midwife-led maternity unit. However, that is still not enough, because we need a consultant-led unit. With our growing town, the Army coming in and the number of houses being built, we will get up to the 2,500 to 3,000 births a year in the coming year, and that will justify such provision, networked together with the University Hospital of North Staffordshire. I will continue to make that case to Monitor and to the Secretary of State.

The question of the critical care unit was also raised. I am glad to say that the administrators accepted the need for a level 3 critical care unit at Stafford, but we need to look at the details in the report, because I want to ensure that the unit is robust and will be maintained and sustained. There are question marks over that, but as I am not an expert on the matter, I will have to wait for the consultants and clinicians in my constituency to get back to me with the details.

I pay tribute to the community in Stafford, Cannock and the surrounding areas who have shown such resilience. When downgrading the hospital to a community hospital was first proposed, they showed tremendous support for its work. As is well known, the hospital has been greatly troubled over the years, but it has come on tremendously in the past two or three years. Only two weeks ago Stafford had the best hospital standardised mortality ratio in the whole of the west midlands. That is a far cry from where it was four or five years ago. I pay great tribute to the community for coming together in marches of up to 50,000 people.

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[Lyn Brown (West Ham) (Lab)]

It is an honour to follow the hon. Member for Stafford (Jeremy Lefroy), who has entertained us with a very thoughtful speech this afternoon. I am going to follow up the health theme, but my discussion of it is going to be a little more graphic. If any hon. Ladies or hon. Gentlemen wish to leave, I shall not take it as a personal affront. They might find it more comfortable to go off and get a cup of tea.

I want to talk about hysteroscopy, particularly when undertaken without anaesthetic. This topic was brought to my attention by my constituent, Debbie, who lives in Plaistow. She was diagnosed with womb cancer or uterine cancer last year. She contacted me because the process of diagnosis, rather than the cancer itself, caused her

“the most distressing and painful experience”

of her life. Debbie underwent a procedure called hysteroscopy, which looks inside a patient’s uterus and is used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. Biopsies are often taken and tissue is often removed. The patient’s vagina is opened with a speculum, as during a cervical smear test, and a hysteroscope is inserted. A hysteroscope is a thin tube with a light and camera on the end, as well as any other instruments that might be needed. As I am sure I need hardly point out, this procedure is highly uncomfortable and clearly has the potential to be very painful indeed.

At present, the NHS Choices website explains

“a hysteroscopy should not hurt, but women may want to take a pain killer such as ibuprofen beforehand”.

As well as a hysteroscopy being an out-patient procedure, the NHS website says that

“the procedure can also be carried out under general anaesthetic, which may be recommended if your surgeon expects to do extensive treatment at the same time or if you request it.”

So far, this sounds fairly reasonable: it will not necessarily be pleasant, but there are options and the procedure can be carried out with or without pain relief and with or without local or general anaesthetic.

Let me tell Debbie’s story in more detail. Through Debbie, I have also heard stories from other women across the country. Debbie told me:

“I was in absolute agony. The consultant who performed my procedure knew I was in pain but carried on regardless. A nurse had to push me back down on the bed as I stiffened like a board. She had to hold me there and had hold of my hands too as I was trying to reach down and stop the procedure. All I could think was that if I made the consultant stop, I would have to come back and endure the whole thing again. This procedure, without anaesthesia, is barbaric. It is absolute torture. It needs to be stopped. At the very least, the patient should be informed that it could be extremely painful and have options explained and open for her. That way, she can make an informed decision as to whether to go ahead without anaesthesia.”

[Bob Stewart]

That sounds absolutely horrific. The hon. Lady did not explain whether Debbie was asked whether she would like a general anaesthetic. I presume that she was not asked and that the procedure went ahead without it.

[Lyn Brown]

Her very next sentence explains that:

“I was given no options. I have complained to the PALS department and to be quite honest I am not happy with their reply. At one point it mentions that the hospital gets more money for the procedure to be done as an outpatient! Is this what it boils down to? Money? Disgusting!”

Jan from Cheshire said:

“I had a hysteroscopy in Cheshire. This hospital is a private hospital but I was there as an NHS patient, as it was the hospital that my doctor could get me into the quickest, for investigations into abnormal bleeding. I saw the consultant in September of 2011, and was given an evening appointment to attend for a hysteroscopy, and was told that the procedure would be done under local anaesthetic. At the evening appointment, I was given a local anaesthetic, but after several attempts at performing the hysteroscopy, the consultant apologised and said that she was unable to perform the procedure and did not want to attempt it again under a local anaesthetic as, in her words, ‘it would be inhumane to continue under a local’. I was sent home and told to take co-codamol for pain relief, and that I was to return the next day for the procedure to be done under a general anaesthetic. I have got to say that even though I had a local anaesthetic”—

if Members have been paying attention, they will know that my constituent Debbie was not offered that—

“the procedure was still very uncomfortable and painful. I have to say that I think offering a hysteroscopy without any form of anaesthetic is barbaric.”

Jo from Chesterfield said:

“I had already had biopsies done in clinic with no anaesthetic, done like a smear with swabs but going through the cervix. I had found this painful but nothing prepared me for what was to come. I had been given a leaflet to outline the procedure but it mentioned nothing about pain or discomfort. I was asked to go behind a make-shift cubicle in the corner, take everything off and put on a gown. I was then asked to sit in a contraption that looked like some Victorian birthing chair, it was very uncomfortable and awkward to sit in. I felt so undignified…I have never felt such pain. I felt like my whole abdomen had been blown up, the pressure was so intense, then sharp prodding pains, I had tears in my eyes, the nurse did come and hold my hand. I just looked at the ceiling and held my breath, praying for it to be over.

When he’d done, the doctor asked ‘did you find that a bit painful?’. I replied ‘no it was excruciating’, he just remarked that most women are fine with it but perhaps I had a low pain threshold and that if I were to need further treatment I would need a General Anaesthetic as I was sensitive. I was quite gob smacked and in so much pain I didn’t really reply. I struggled to my car and drove home, I was in agony for days. I felt almost like I’d been violated, like a piece of meat, but thought perhaps it was just me, perhaps I was being a wuss. It wasn’t till I spoke to other ladies that I discovered it needn’t have been this way. My treatment on a whole I feel was done very wrongly, cutting corners and saving money, at my expense. The hysteroscopy should not have been done this way, it’s almost inhumane.”

Katharine from Bath said:

“My GP referred me for day-case hysteroscopy under local anaesthetic…He told me to pay for a course of Cognitive Behavioural Therapy to lower my Blood Pressure to qualify me for NHS day-care surgery as opposed to more expensive NHS inpatient surgery. During the Cognitive Behavioural Therapy the psychologist told me to go straight to the gynae-oncology surgeon at the hospital and have my persistent inter-menstrual bleeding properly investigated. My GP was furious at this suggestion but eventually gave in. The gynae-oncology surgeon told me that ‘you’ve had it for so long it won’t be anything sinister’. He eventually agreed to an inpatient hysteroscopy under General anaesthetic. I waited months for the operation. It showed late stage womb cancer which had spread to the lymph nodes. I had a radical hysterectomy and a long course of external radiotherapy”.

Jenny from Barnsley said:

“I went into the clinic and was given an ultrasound and very quickly was approached by a senior registrar who said I had a very thick womb but they could do a biopsy there and then.

My GP had mentioned that this procedure can be difficult but they would give me a local anaesthetic.

To be honest I was in such shock. I was led into a room where there was a very nice sister and nurse. I sat in a chair and the senior registrar began by filling my womb with water.

Then the hell began when they inserted whatever and did the biopsy. I have not experienced such pain even in childbirth and I told her so. I also said my GP had said they would give me some local anaesthetic and then she asked if I wanted some. Rather like closing the stable door after the horse has bolted. It was too late then as they were in there.

The sister told me she nearly stopped the doctor. They were very caring then but only offered me one paracetamol. They said to me don’t let the woman who is waiting outside see you or it might put her off.”

The 21-year-old sister of Michelle, from Scotland, went for a hysteroscopy after noticing some bleeding after intercourse. The gynaecologist asked a nurse to assist while he proceeded to perform a rather forceful examination, and then carried out the hysteroscopy with no warning or pain relief. Michelle received a phone call from her distraught sister, who had gone into shock in the car park, had passed out next to her car, and was bleeding.

Gillian in Leeds said:

“Before the procedure, I received a leaflet with my appointment letter—no mention of any general or local anaesthetic, but after what the doctor had told me I wasn’t expecting it to be too bad”.

She said that the nurse

“managed to get the hysteroscope through my cervical opening…when she took each sample—6 in total—my pain level shot through the roof.

“What...infuriates me most is the fact that SOME people are given pain relief as a matter of course at their hospitals…why the hell should I, and others, have to suffer just because of which hospital we went to?”

Patricia from Fife said:

“I was offered no pain relief and the Dr. who did it didn’t get enough in the end so I had to go under general anaesthetic to get it done again.”

The procedure that she experienced, while conscious,

“was very traumatic and painful…I felt them cutting away the biopsy inside…afterwards the nurse who had held me down said to me ‘I wouldn’t have let them do that to me without a general anaesthetic’ so why did she let me go through it?’”

Maureen from Norwich said:

“The letter…advised I took either ibuprofen, or paracetamol about two hours before the appointment. The scan showed something abnormal, so I waited and then saw a very nice lady doctor. I then went on to endure the procedure, it took about fifteen minutes and it was certainly a lot more than uncomfortable.”

She felt very sick, and was in pain, but

“the nurse who was there kept saying how well I was doing. I was at the limit of my endurance, only the thought of having to go back again stopped me from asking the procedure to be stopped.”

I have received so much correspondence about this issue, via my friend Debbie, that I could speak at length and give many more examples, because what I wanted to do today was give those women a voice. However, I think that the House will understand the direction in which I am going.

Some women have received no pain treatment at all—no anaesthetic to dull the pain. Some have received a local anaesthetic, but, given the severity of their conditions, a number of them have found that that is not enough. Others have received a general anaesthetic, either on request or because their doctors were aware that the procedure involved might be more extensive than had been expected. A study of a group of women conducted over five years in Melbourne established that over 10% of the group would not accept a local anaesthetic again, because of the pain and the need for the procedure to be repeated owing to a failure to secure a biopsy sample.

I have found it difficult to obtain information about this issue, but I think that certain facts are clear. Some women are being given no pain relief options at all. That aspect is not being explained to them by the doctor when they get to the hospital. Some feel that they are not being treated with compassion and respect, and that very little or no consideration is given to their dignity or their well-being. Some are experiencing a procedure that fails and needs to be repeated. One has to ask how often that happens, and what the cost is to the NHS.

Some women are clearly receiving treatment that is not in line with the guidelines issued by the Royal College of Obstetricians and Gynaecologists, which acknowledges that

“outpatient hysteroscopy can be associated with significant pain, anxiety and embarrassment”.

While the RCOG’s guidelines emphasise throughout that it is possible for women to have an acceptable out-patient experience, and some women do, there is clearly a serious problem, in that the current standard practice is failing a significant group of women very badly. It is appalling that, in some cases, no pain relief is even offered. I have read a range of the information leaflets that various hospitals offer to support their hysteroscopy out-patient clinics, and I am glad to note that local anaesthetic is mentioned in almost all of them, but they are not open enough about the pain that women may experience during and after the procedure, and there is inadequate reference to the option of undergoing the procedure with a general anaesthetic.

[Bob Stewart]

May I ask what percentage of women feel no pain whatsoever? Is there such a percentage, or does everyone experience pain—in which case, we must sort the matter out?

[Lyn Brown]

I honestly cannot answer that question, although I can say that at the different times in my life when I have had internal examinations the pain has varied, and that as I have got older, the examinations have become more painful. I have been told by some women who have had babies—which, sadly, I have failed to do—that they have found the examinations less painful after their pregnancies. However, some have told me that they become more painful with the menopause. Indeed, when my mother had a similar examination, she told me that it had been excruciating, and that was when she was quite old.

I am not sure that there are any research findings out there that would answer the hon. Gentleman’s very sympathetic question—certainly I have not found any—and I think that this is something that we need to know more about. However, a study published by the British Medical Journal in 2009 concluded that a local anaesthetic injection was the best method of pain control for women undergoing hysteroscopies as out-patients.

I have struggled to decide what I need to ask the Government to do in order to ensure that women receive the best possible care and treatment while undergoing this procedure. It is difficult for me to know that, because I am not a medic. However, I do think it is reasonable to ask the Government to use all the influence they have over policy in this area to require the National Institute for Health and Care Excellence to work with the Royal College of Obstetricians and Gynaecologists to issue authoritative guidelines. I also think the Care Quality Commission may well have a role to play in ensuring that best practice is delivered locally at each hospital.