NHS: Hysteroscopies

Jackie Doyle-Price Excerpts

Tuesday 11th December 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Howarth. It is an even bigger pleasure to respond to the hon. Member for West Ham (Lyn Brown). I pay tribute to the work she has done to highlight this issue, which has affected many women over many years who have been left to suffer in silence.

As the hon. Lady said, there were 47,000 signatures on the campaign petition, which is an indication of just how many women have been badly affected by what is actually a common procedure. It does not matter that it is only one in four, which is probably the most generous estimate. It could be as low as one in 10; it does not matter. We are talking about individuals who have been badly affected and who have been traumatised to the point where it effects their ability to look after themselves in the future. Frankly, it is no value to the NHS to leave those women suffering in silence, and I am very grateful to the hon. Lady for sharing the experiences of the women who have been brave enough to come forward.

The hon. Lady set me a challenge. She is quite right to demand swift action, because this has been going on for many years. She had four asks. On the first two, I will work with her and the campaign to make sure we can deliver them. They are extremely reasonable, to be brutally frank. On her third ask, we need to make sure that we have sufficient resource to enable women to exercise genuine, informed choice about how they take this procedure. On the fourth ask, about the tariff, notwithstanding the guidance about what might be best practice in most cases, we need to make sure that the tariff does not encourage perverse incentives that will disadvantage women. At the heart of all this, we need to ensure that running through every piece of treatment for women with gynaecological conditions is the ability to make informed and empowered choices—genuine choices. In that respect, I see the hon. Lady as a strong ally in working towards far better treatment for all women at the hands of the NHS.

The hon. Lady has given a great voice to people who have been through such terrible experiences. She again shared some of the distressing accounts of women for whom current practice has not been good enough. She is right that in the past not enough attention has been paid to a common procedure that generates harm to far too many women. I hope that the very fact of our debate today will shine a light on the situation, because the more we can do to spread awareness, the more women are empowered to look after themselves when facing treatment in the NHS. I hope that she will take some reassurance from the fact that I will continue to work with her to improve women’s health outcomes.

I also want to put something else on the record: the hon. Lady talked about a complete lack of humanity in how those women were treated. I would not be the first to say this—I have spoken to many female colleagues across the House as well—but we often feel that, when our reproductive organs are not being used for the purpose of having children, they are just an inconvenience. The NHS needs to do better. She mentioned my women’s health taskforce, and it is very much at the heart of that. As we go through life, the virtue of having our reproductive organs brings morbidities which are not always treated well in the NHS. We need to do better.

Hysteroscopy, as the hon. Lady explained, is a useful tool in the diagnosis and treatment of a number of conditions, such as the investigation of heavy menstrual bleeding, which affects as many as one in four women between the ages of 15 and 50. That gives some indication of just how many women might consider the procedure. Hysteroscopy is also used to treat fibroids and polyps, which are conditions that can cause long-term symptoms of pain and discomfort. The procedure is without doubt useful in treating women, so hysteroscopies have a role, but as she illustrated beautifully, they can be invasive and traumatic. We need only think about what the procedure involves to understand how traumatic it can be when it becomes painful.

Women’s least expectation of going through the procedure—this is crucial—is that they should be treated with sympathy and respect. They should also have full understanding before undertaking such an experience. As the hon. Lady explained, however, often women find themselves in profound shock at what is happening, and it does not always take place in the most appropriate setting. We clearly need to do better. Information is crucial in that regard: we need to ensure that nothing comes as a surprise.

I encourage women to access the NHS webpage on hysteroscopy, which includes information on what the procedure involves, the likely recovery period and the alternative procedures available. It notes that experiences of pain during a hysteroscopy can vary considerably from one woman to another but—the hon. Lady highlighted this point—I do not think that it properly reflects that, for women who have never had children, the pain can be particularly acute. We should consider the question whether it is ever appropriate for women who have not had children to have the procedure. Clearly, from the evidence she has presented to me, that is where the highest risk is.

I also feel strongly that merely giving information is not enough. Not only is this about providing clarity about what will happen and whether there are decision points for patients—some women will experience little or no pain, but for others it can be severe. We should also remember that for some women the hysteroscopy might be a first encounter with gynaecological services and that some might need to confront past pain or trauma. The hon. Lady has illustrated that well today. It is concerning when medical professionals do not prepare patients for the treatment in a sensitive way.

I fully agree with the hon. Lady that when a woman is clearly suffering during the procedure, it should be stopped. In any case, consent means that at any point people should be able to request that a procedure is stopped. It horrified me to read some of the accounts that she shared, such as women being held down and told, in essence, “You’ve got to continue this treatment or it will be worse for you.” That sort of conversation does not belong in 21st-century Britain in our fantastic NHS. I think we would all agree, women need to be treated better in that regard.

I also agree that we need better training on pain relief and managing women who are to have what can be a traumatic procedure. For practitioners, gynaecological procedures might be an everyday thing, but us women who present ourselves for such a procedure might have to have an out-of-body experience to go through it, because it is not comfortable—[Interruption]—excuse me—to have people engaged in that. We need more sensitivity—[Interruption.] Excuse me, Chair, I have a terrible cold.

The Royal College of Obstetricians and Gynaecologists has produced a guideline to provide clinicians with evidence-based information regarding outpatient hysteroscopy—[Interruption.] Excuse me—[Interruption.]

[Mr George Howarth (in the Chair)]

Order. The Minister is clearly in some distress. She must feel that she has more to say, but it would be perfectly in order if she wished to conclude the debate at this point. How can I put this? In these troubled times, it is really nice to see the amount of co-operation taking place across the Chamber. We have established that there is a consensus, so if she feels that she is still in some distress, it is perfectly acceptable if she wishes me to put the question, or we can continue—it is her choice.

[Jackie Doyle-Price]

I give way to the hon. Member for West Ham.

[Lyn Brown]

I am really grateful to the Minister for her response thus far. I have found her, to be honest, to be the only Minister I have been able to have proper conversations with about such issues who has understood them. I am grateful. However, I honestly believe that we need to do something about the fourth ask. I am a fairly strong woman, but even I was in such a position: I had requested a hysteroscopy with general anaesthetic, but the hospital spent an hour of its time trying to talk me into having one without anaesthetic. I am in a high-risk category of being an older woman and of not having had a child, but I had to beat off the medic who was trying to use every piece of emotional blackmail that she could to get me to agree—the cost to the NHS, taking up resources, the possibility that I had cancer or of a long wait, and so on. It was an uncomfortable conversation. If we do not get rid of the perverse financial incentives, even women as strong as me will be browbeaten.

[Jackie Doyle-Price]

I thank you, Mr Howarth, and the hon. Lady for the generosity of allowing me to recover myself. We can tell it is December, because we all have colds—thank you very much.

In the short time I have left, I will address the specific issue of the tariff and the possible incentives, which I know the hon. Lady is particularly concerned about. She is right that there is a best practice tariff that incentivises care in a day-case setting with no anaesthetic, just pain relief. That tariff is agreed with the Royal College of Obstetricians and Gynaecologists, but it is revising its guidance. I want to engage the hon. Lady and the campaign group in that process through the women’s health taskforce, so that we can all satisfy ourselves that the guidance is appropriate. She is absolutely right: if someone such as her or me—women Members of Parliament—cannot look after ourselves, neither can anyone else, and I have heard many tales of people often feeling diminished at the hands of the NHS. She and I have the opportunity to use our voices to ensure that women get a better deal.

I again thank the hon. Lady for all her work. I look forward to continuing to work with her to ensure that all women who face that procedure can do so with sensitive treatment and appropriate pain relief.

Question put and agreed to.