NHS Hysteroscopy Treatment

Feryal Clark Excerpts

Tuesday 31st January 2023 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. I thank my hon. Friend the Member for West Ham (Ms Brown) for securing this debate, and for her tireless campaign on the matter. It has been 10 years with almost 10 debates, and she is still going. Numerous Ministers have committed to making this a priority. As we have heard, there have been some improvements, but nowhere near enough to make a difference to the lives of women. I praise the incredible contributions from the hon. Members for Thurrock (Jackie Doyle-Price) and for Strangford (Jim Shannon), and my hon. Friend the Member for York Central (Rachael Maskell).

As we have heard, a hysteroscopy is a procedure used to examine the inside of the uterus. It involves dilation of the cervix, sending fluid into the uterus to expand it so clinicians can examine the uterus and the fallopian tubes, and the use of surgical instruments to examine the inside of a woman. It is an essential tool for diagnosis and treatment of many conditions affecting women, including unusual bleeding, pelvic pain, recurrent miscarriages, difficulty getting pregnant and many more. When I had my hysteroscopy, I had had several miscarriages and I was desperate for a baby. When I was offered this procedure for further investigation, I read every side of the leaflet and looked into it. Not only did I take paracetamol; I took ibuprofen, to ensure that I did not have the “little discomfort”.

I turned up and there was a lovely nurse, who was very softly spoken. A nurse stands next to the patient to talk them through it, and holds the patient’s hand. If it is a “slight discomfort”, the whole process of having someone standing there trying to be a guide through it, is worrying. It is the most excruciating thing anyone can go through. It may have been a 10 on the scale. I do not understand how even slightly lower than that could be acceptable for any human being.

I was asked things and the nurse kept talking to me, but I could not respond. I was in so much pain. Because I was so desperate for that baby, I would have walked over broken glass with bare feet. I did think about continuing through the pain, but luckily I passed out and the procedure ended. It is not acceptable in this day and age that women have to go through that level of pain for healthcare.

[Jackie Doyle-Price]

I thank the hon. Member for sharing a very personal story. She lands an important point. When women are desperate to fulfil the urge to give birth to a child—a deeply biological impulse—they will go through anything, as she rightly says. Does that not tell us that the degree of pain we are aware of could just be the surface?

[Feryal Clark]

I wholeheartedly agree with the hon. Member. It develops a level of acceptance, which is not right or acceptable. Hysteroscopies are paramount to women’s health, but we have heard horrific accounts from my hon. Friend the Member for West Ham of women’s experiences of having the procedure. That should never have happened to women, and those women affected are right in their fight for justice. There is a lack of information or no information about the choice of pain relief available before, during or after the procedure. Paracetamol is not enough. There is an assumption that the patient will experience only discomfort—in my case, it was slightly more than that—despite some women experiencing intolerable pain. If they do experience that so-called discomfort, the assumption is that it does not matter because it is only short lived.

It is astonishing that the NHS still does not collect data on the number of women who experience severe pain during hysteroscopy. However, the Campaign Against Painful Hysteroscopy, which does undertake surveys of women, has found that more than 90% of women surveyed were traumatised for a day or longer by the pain. Three quarters said they were not aware of pain management options before the procedure was carried out. In 2020, half of NHS hospital trusts in England failed to warn patients that they could suffer pain. Women are simply not given the information they need to make informed decisions, which must include information on potential pain, options for pain management and alternative procedures. Let us be clear: a woman should not have to experience excruciating levels of pain to access essential healthcare.

As we have heard, the national tariff creates an incentive for hysteroscopies to be carried out as an out-patient. We cannot deny the obvious advantages of out-patient care. For example, it allowed women to access hysteroscopies more easily during covid, and can reduce the time women have to wait for diagnosis and treatment, but it does not allow for patient choice and patient voice. Some 61 out of 131 NHS trusts admitted to the Campaign Against Painful Hysteroscopy that they did not warn patients about the risk of severe pain, and this could lead to unnecessary pain for women. Informed consent, choice and effective communication is not the norm when it comes to women’s health; it is barely there. That cannot and must not continue.

While some women are left in excruciating pain, some women hear those stories and decide not to have the procedure—I am not sure which is worse. No woman should feel discouraged from attended a hysteroscopy appointment for fear that they could experience pain, because, as mentioned earlier, hysteroscopies are an essential tool in diagnosis and treatment of women’s health.

The Royal College of Obstetricians and Gynaecologists’ guidance states that all pain relief options should be discussed with women. I welcome that those guidelines are being updated, but the clinical guidance currently in use is over 10 years old. Today is not the first time Ministers have been made aware of the seriousness of the issue for women, so why did the Government not ask for the guidance to be updated sooner? Will the Minister tell us what she is doing to ensure that the new clinical guidance will be in place as soon as possible, for all clinicians to use? We must ensure all women have access to the pain management they are entitled to. How is that being monitored, because it does not seem to be happening currently?

Improvements in hysteroscopy care are included in the women’s health strategy, which was published late last year, as the hon. Member for Thurrock mentioned. The Minister is responsible for the women’s health strategy, and it is her ambition that women and girls report better experiences of procedures, such as this one. However, the Minister’s letter, setting out her year 1 priorities, which she sent around last week, did not mention hysteroscopies. How many women will continue to have the procedure in pain, or not at all, as a result of it not being considered a priority? Will the Minister explain to us, and to all those women who face having the treatment, why it is not considered a priority?

Finally, painful hysteroscopies are just another iteration of no care being given to women and their health. Yet again, women have been given empty promises of improved care. How many more stories must we hear about women in unnecessary pain? How many more times must we hear that women are not listened to in healthcare settings? And how much longer must women wait for the healthcare they so desperately need?