Lyn Brown
Main Page: Lyn Brown (Labour - West Ham)Department Debates - View all Lyn Brown's debates with the Leader of the House
(10 years, 11 months ago)
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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.
Bob Blackman
I have listened with horror to these terrible experiences suffered by women. Is the hon. Lady aware of any other such treatments to either men or women where anaesthetics are not provided yet people are in such pain on such a general basis? That would clearly be a matter of the whole health service not doing a proper job, compared with a narrow field that we can possibly deal with very quickly.
John McDonnell
A fair amount of survey work was done in respect of the all-party group on endometriosis, which produced very similar findings of inconsistent practices and practices that were incompatible with the well-being of the individuals.
Lyn Brown
I am grateful to my hon. Friend for that intervention and I will look at that research if he signposts me towards it.
I promised Debbie that I would make her voice and the voice of other women who have had similar experiences heard today, and I hope I have done that, but merely hearing the voices is not enough. This Government have the mantra of no decisions about me, without me, and that policy needs to be adopted in gynaecological procedures so that I and other hon. Members do not have more Debbies coming to our surgeries to tell us about their horrific experiences. I am hoping that the Deputy Leader of the House will take this to the Department of Health on Debbie’s behalf and on behalf of the other women, and I would hope that I will receive some communication from it in the new year telling me that Debbie, Jan, Jo, Katharine, Jenny, Michelle, Gillian, Patricia, Maureen and the many other women I have heard from will be well and truly heard.
May I thank hon. Members for staying in the Chamber for my contribution this afternoon and may I also wish everyone, including the staff of this House, a happy Christmas and a very happy and prosperous new year?
Bob Blackman
When we were gathering evidence for our report, the Communities and Local Government Committee went to Berlin, where people have much longer tenancies and where a partnership approach is taken between the tenant and the landlord. That is a much more appropriate way of dealing with these matters. Unfortunately, the use of six-month assured shorthold tenancies has grown in this country, more often than not to protect landlords by giving them the right to evict a tenant and recover the property if they so choose. These concerns clearly need to be addressed. We need longer tenancies that give greater assurance to tenants and place greater responsibility on landlords. It would also be helpful if landlords became members of the housing ombudsman service. In that way, they would be more likely to carry out the necessary work and the tenant would have a means of complaining if that did not happen.
I am sure that all hon. Members have houses in multiple occupation in their constituencies. When five or more persons form two or more households in a building, it is a requirement for the landlord to register that property as an HMO. Unfortunately, there can be all sorts of issues involved, including whether fire safety standards are being met. It is a fact of life that, under the terms of the Housing Act 1985, the maximum penalty for operating an unlicensed HMO is currently £20,000. In my borough, there are 89 registered HMOs. I encountered a case three weeks ago in which a three-bedroom semi-detached property was found to be housing no fewer than 11 adults, none of whom was connected in a family sense. They were sharing bedrooms and all the other facilities, and they were each paying £160 a week in rent. That was a nice little earner for the landlord. The property was not registered as an HMO. There are now 100 such cases under investigation in Harrow, and I believe that they represent the tip of a very large iceberg.
Lyn Brown
I recognise much of what the hon. Gentleman is saying. Those problems are certainly replicated in Newham. During the last Parliament, I tried to get HMOs reclassified according to the actual occupancy, rather than to the size of the house. Does he agree that such a reclassification would be very helpful?
Bob Blackman
I agree completely that that is one remedy we have to take on board.
I cannot speak about what is happening outside London, but in London the charges for HMO applications vary: Harrow council charges £1,200 for an application, which lasts for five years, and then there is an £850 renewal fee; Brent, our near neighbour, charges between £800 and £1,200, depending on the licence length; Ealing charges £970 plus £30 per habitable room; and Lewisham charges £180 per unit of accommodation, up to £1,800. Non-London authorities seem to charge much less. The fee seems to be discretionary and a council could drop it to encourage registrations, thus enabling properties to be examined and tenants to be protected.
As we have seen, we also face a challenge on beds in sheds. The Prime Minister was taken this week to a property in Southall that would have disgraced a third world country, yet a number of individuals were being forced to live in incredible conditions there. The Government have taken some action to try to close down beds in sheds, but often we are talking about illegal immigrants in accommodation tied to a job they are undertaking, which is provided through gangmasters and the equivalent. In addition, service providers such as local authorities and the health service are being forced to provide services without any income coming in; these properties will attract a certain amount of council tax, but not the sort of sum they should, given the number of people living in them.
Last May, £1.8 million was given to nine councils to tackle the problem of beds in shed: Brent, Ealing, Hillingdon, Hounslow, Newham, Peterborough, Redbridge, Slough and Southwark were all given money. The trouble is that that addresses only the tip of the iceberg; it does not address all the other boroughs where the problem is occurring. Ealing subsequently stated that it had carried out 4,500 site inspections in a year, in addition to unannounced fortnightly raids, but unfortunately the landlords were running rings around the officers.
In February, a BBC “Inside Out” investigation found two high street estate agents renting out beds in sheds without residential planning permission, including one in Willesden Green, in Brent. Rent payments of £1,000 per month were being taken. It was noted that the owners often claim that these converted buildings are more than four years old and so cannot have planning enforcement taken against them by the local authority.
Some actions have been taken across England on this issue. Slough borough council spent £24,000 on conducting a heat map across the borough during the early hours of the morning. That identified 6,139 properties where it was believed that beds in sheds were operating—that is just in one borough, which shows the extent of the scandal. The hon. Member for West Ham referred to Newham, and the Communities and Local Government Committee has taken evidence about the action that its mayor and council are taking to identify and take enforcement action against the outhouses that are being put up without planning approval. I believe that that work has been extended to tackle other illegal activities by landlords. I understand that over the past year the council has taken 80 enforcement actions on beds in sheds, but a further 230 are still pending against properties in multiple occupation, which shows the extent of the problem in one London borough. We might have extended negotiations with landlords, but it seems as if these rogue landlords, who give other private landlords a bad name, need to have stringent action taken against them.
We must also consider the fire risk. The London fire brigade has estimated that over the past four years there have been 341 fires in buildings that appear to have had people living in them when they should not have been. Those blazes have caused nine deaths and 58 serious injuries.
I have mentioned the fact that illegal immigrants are often in such properties. We might reason why that would be. Migrants who are not here legally are often given low-paid jobs, are paid in cash and have insufficient income to pay the normal rents for accommodation, so they take accommodation from the employer or gangmaster in order to maintain their presence here. They also want to be able to send money home to their families. They are kept in poor conditions, under threat of being reported to the authorities and sent home. There is a lot of anecdotal evidence of people traffickers accommodating their victims in illegal structures, particularly in the London borough of Ealing. Furthermore, if the trafficked victims escape and get work as undocumented migrants, they may resort to living in illegal structures anyway because the rents are often lower and more affordable from their low earnings.
Lyn Brown
I thank the hon. Gentleman for his kind words about Newham. The action that the council has taken over the past couple of years has been important and effective in probably saving lives. We had a death in a shed from a fire way back before 2010. Local schools tell me anecdotally that people who are here legally and who have status are not necessarily aware of their rights. People who have come from abroad and are living here on very low incomes are exploited by the unscrupulous landlords he has been talking about.
Bob Blackman
Clearly, as the hon. Lady says, people who are here legally and have the proper status are often not aware of their complete rights and therefore are exploited by unscrupulous individuals acting as landlords.
One of the consequences of the changes in housing benefit has been to encourage young people under the age of 35 to go into shared accommodation because that is the only rate of housing benefit they will qualify for. I welcome that as a move towards ensuring that accommodation is used properly, but as more and more people share housing in the private rented sector, there is the unfortunate consequence of overuse and overcrowding of such properties.
Under the right circumstances a local authority may be able to force a landlord to repay rent or housing benefits if an HMO is unlicensed. Unfortunately, it appears that this is not well known among the public or even among London authorities or councils outside London. If it were known about, it would immediately dissuade landlords from taking in vulnerable people on benefits and exploiting them.
What do we do about the problem? It is up to local authorities to enforce the rules. If a landlord is operating an HMO—I have written to my council about a huge number of properties that I suspect are HMOs but are unlicensed—appropriate and stringent enforcement action needs to be taken to fine the landlord and to make sure that the properties are brought up to a decent standard. A clear attitude should be adopted towards rogue landlords who give good landlords a terrible name.
Proper advice needs to be given to people who rent properties so that they understand their rights, what they can demand and what they can take on. There should be accreditation and licensing for private landlords, particularly those that choose to operate HMOs. It should be for Government and the Department to ensure that tenants and landlords are educated about their rights and responsibilities.
There is hope on the horizon. There was a case in which a landlord, who happens to live in my constituency, was operating a property empire in the neighbouring borough of Brent, where he put 28 flats into four houses. He was prosecuted and ordered to pay £303,112 under the Proceeds of Crime Act 2002. This demonstrates that local authorities can use their power to stop rogue landlords in their tracks and take appropriate action. Rogue landlords will listen to only one thing: losing their income and assets. We must ensure that the people living in those properties are given decent facilities to live in.