NHS Hysteroscopy Treatment

Jackie Doyle-Price Excerpts

Tuesday 31st January 2023 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Mark. I wish I could say it was a pleasure to follow the hon. Member for West Ham (Ms Brown). I have genuinely enjoyed working with her on this subject for quite some years. But it is not a joy to follow her in this debate, because it is frustrating that we are still having the same discussion. It feels like groundhog day; it has been four years since I ceased to be the Minister responsible for this issue.

The hon. Member for West Ham reminds me that I started the moves towards the women’s health strategy, and established the women’s health taskforce, exactly because of the stories that she tells. It was very clear to me, when I started to look at this subject, that ultimately all the female Members of Parliament who are present have had terrible experiences at the hands of the NHS. We are very good at looking out for ourselves. If that has happened to us, then it is something that is being repeated for women up and down the land. It is something that we must address properly.

At the heart of what the hon. Member for West Ham is talking about is the principle of informed consent. Informed consent is the underpinning principle of our NHS. The stories that the hon. Member has outlined this afternoon show negligence around consent. They show women being referred for what is an investigatory procedure, not a treatment, without any proper consideration as to what they need to understand before consenting to such a procedure. The truth of the matter is that women find themselves undergoing a procedure in terrible pain before they even know what is happening to them. In 21st-century Britain, that is not acceptable.

We have made a lot of progress on centring women when we look at health, and ceasing to treat them as walking incubators for babies. We are human beings and we need to have our needs properly considered when we consent to treatment. We now have a women’s health strategy, which shows we have made some progress.

However, the hysteroscopy procedure has not received the attention that it deserves. Although two thirds of women who have the procedure go through it with less pain than in the cases we have heard today, a third of women experience terrible pain. That this is not properly explained to them is appalling. I have heard cases where women are just told to take some paracetamol before they go in and there will be no problem. For those women who do experience pain, as the hon. Member for West Ham has outlined, it is very severe. We must ensure that we have proper, well-understood protocols that govern how this procedure is managed, and how women are engaged in it.

The hon. Member for West Ham draws a parallel with mesh implants, and I think that is absolutely right. Again, the issue of informed consent was missing in many of those cases. We found that the mesh treatment was being routinely recommended to women after childbirth, women were not having any risks explained to them, and then, low and behold, they were suffering debilitating problems for the rest of their lives. As we roll forward with the women’s health strategy, we must stress-test exactly how much information we are giving to women, so that we can make informed consent an absolute reality.

The truth is, our wombs are not just here to incubate babies; they are part of us. The women here will have all had to go through invasive examinations internally. They are not very nice experiences. I do not know about anyone else, but when I have to do that I have an out-of-body experience where I zone out of what is happening to me. These women cannot do that, because they are suddenly visited with terrible pain. They cannot zone out of the fact that somebody is fishing around between their legs; they are living that, and that is an absolute trauma—a trauma that will stay with them for the rest of their life, notwithstanding the other side effects that they experience.

The women’s health strategy has alluded to some of those aspects, but I do not think it has taken up the issue with sufficient seriousness. It talks about the need for conversations about pain relief before a hysteroscopy procedure, but it needs to be a lot more than that: people need to be given sufficient information to enable them to decide whether or not they even want that examination. As many as 10% of women suffer with problem periods, fibroids and the kinds of conditions that would lend to them having such an investigation, but we need to be able to make that informed choice—“Is it really going to make a difference?” Frankly, if you are 71 years old, what difference is it going to make? All it is going to do is establish the cause of the bleeding. You might be better off managing that condition, because if there is going to be no end of treatment following the hysteroscopy, the whole thing is absolutely pointless, with a substantial degree of risk.

I am pleased to hear that the Royal College of Obstetricians and Gynaecologists is updating its best practice guidelines. I ask the Minister to consider inviting the women’s health ambassador, Lesley Regan, to carry out a proper stress test of everything around this issue. I had the pleasure of working with Lesley when I invited her to co-chair the National Women’s Health Task Force: she brings considerable expertise, including as a gynaecologist who is a woman. The truth is that far too many gynaecologists are male, and with the best will in the world, I do not think they are ever going to understand, let alone care about, the degree of pain that is being administered to their patients. I am really pleased with that appointment: Lesley is a fantastic advocate for women’s health, but I would like her to look at this issue properly so that we have a good set of ideas, advice and principles to help women make informed choices, and to make the medical profession understand exactly what difficulty this procedure involves for some women.

I invite the Minister to put that advice alongside some advice about healthy periods generally. Women need to be encouraged to take ownership of their gynaecological and menstrual health, but again, they can only do that with sufficient information. We will not avoid situations where women rock up to hospital for an appointment and, the next thing they know, find themselves on the trolley in stirrups without properly understanding what is happening to them unless everyone understands what good menstrual health looks like; what the alert factors are for some of the conditions that might invite a hysteroscopy examination; and what potential treatment might follow.

The hon. Member for West Ham has outlined the painful experiences that some people have had, but we all need to understand exactly what is involved in a hysteroscopy. It is an internal examination of the womb, which is undertaken by the insertion of a camera through the cervix. We know from the evidence that the hon. Lady and I have examined that women who have not had children are particularly affected by pain. If we think about what that procedure involves, it seems like a no-brainer that women who have not had children would suffer more pain, so again, I cannot get my head round the negligence with which women are referred for this procedure without proper consideration of the pain involved.

[Barbara Keeley]

I want to emphasise this aspect of the issue, based on what I was told by my constituent: the leaflet did not mention that the procedure can be stopped if the patient is unable to tolerate it. Can the hon. Lady think of another medical procedure that is run without anaesthetic on that basis—that it can be stopped if the patient cannot tolerate the pain? There are not many other examples.

[Jackie Doyle-Price]

No, and the interesting thing is that, in theory, a patient should be able to stop anything. That is what informed consent should be about. Again, it illustrates the relationship that we have with our health service. We naturally defer to medical professionals. We assume that they know better than us, and perhaps that is where we need to alter our relationship. These are human beings; they are not gods.

We need to be empowered to take more agency and ownership of how we approach these things. Listen to the description by the hon. Member for West Ham of Julie removing her hearing aids: there is no way that she was in control of that situation. How can a patient make informed consent and have the ability to stop something that is causing them significant distress and trauma in those circumstances? As I mentioned, it is extremely painful, especially for those women who have not had children.

We know that some women are just told to take paracetamol before they arrive, and there is a massive discrepancy from organisation to organisation when women try to exercise their ability to choose whether they have a general anaesthetic. In some cases, women are told that that is not really the best thing for them; in others, as we have heard, that elective choice was made quite easily. To me, that brings a real worry that too many in our medical establishment are not giving their patients the respect that they deserve. That is something that we really need to change in the culture of our NHS. It is all about behaviours, ultimately; we need to look at how we can encourage better behaviours towards patients throughout the system.

In the short time that I have left, I will make some specific asks of the Minister. I have mentioned that I would like her to invite Lesley Regan to properly stress-test this, but we need a proper risk assessment tool for each woman undertaking the procedure, so that both they and the medical professionals they are dealing with can make an informed choice on whether they are more or less likely to suffer the substantial pain that has been outlined in the debate. I also invite the Minister to consider the work of Baroness Cumberlege in “First Do No Harm”. One of the themes running through that work—and again, I mentioned mesh earlier—was the absence of informed consent. One of the conclusions we drew was that we need a proper patient’s voice to be able to stress-test those incidents where there is widespread poor practice in the NHS.

Ultimately, the NHS is a producer-driven system. We have care pathways that are very much process driven and not practitioner or patient driven, frankly. We must help practitioners to help themselves by empowering patients, because they need to have that mutual understanding on the same level. I invite the Minister to consider properly the establishment of a patient commissioner so that we have somewhere to refer these incidents of widespread poor practice.

We have outlined today the serious harm being done to women put through the procedure without appropriate care. That is doing real harm, and if we are going to have an NHS that works for all patients, we need to address incidents such as this extremely quickly.

--- Later in debate ---

[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?