Gynaecological Services: Waiting Lists

Lyn Brown Excerpts

Wednesday 6th July 2022 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is an absolute pleasure to serve under your chairship, Mr Robertson. I will not detain hon. Members long with my speech, but I do want to say how grateful I am to my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and what a privilege it is to follow her excellent contribution. So much of what she said about waiting causing harm and the attitude of health services to women I will echo in my speech, because today I want to talk about waiting lists for women who need hysteroscopy.

The thing that I want to emphasise today is that many of those women are having to make a terrible choice—a Hobson’s choice. Either they have that really important procedure—it will determine their health prospects—as soon as they need it and without an anaesthetic, or they can wait and wait and wait until an anaesthetist and a theatre are available. I have now spoken about the issue of painful hysteroscopy in the House nine times, trying desperately to get Ministers to secure a change in the behaviour of the NHS towards women. And every time I speak, more and more women contact me afterwards to tell me about the brutalisation that they have experienced. The stories never stop. Although I am assured by Ministers that action is being taken, will be taken and so on, the stories just go on.

I will share just two stories today. Had I known that only my hon. Friend the Member for Kingston upon Hull West and Hessle and I would be here on the Back Benches, I would have brought more—because I love to watch a Minister squirm—but I have only two stories with me today.

I want to talk about Emily, who is in her 70s. She gave birth twice—once without pain relief, after a very long labour. Therefore, we are talking about a woman who can cope with a certain level of pain without difficulty. When Emily, who is, I repeat, in her 70s, had her hysteroscopy, she was not offered any pain relief, and her procedure was excruciatingly painful. The word that she uses and that many, many women who have written to me use also is “brutal”. The pain was so bad that Emily, in her 70s, passed out. It is appalling, and every single person sitting in this room and watching from home knows that. Emily should have been given the decent, fair choice of having the procedure with an effective anaesthetic and without having to wait months.

We all know that hysteroscopies can be absolutely essential to investigate and diagnose serious medical conditions. But frankly, given the state of the NHS at the moment, women are in effect told to tolerate no pain relief or wait months. That is not acceptable. It means week after week of waiting while knowing that they may have a cancer. It is not acceptable to give them the choice of either having the procedure without pain relief or waiting months to have it with pain relief. They remain undiagnosed and untreated for months.

Imagine being one of the increasing number of women who are aware that hysteroscopy could cause, or has caused, them horrific pain and lasting trauma. Imagine having to wait to make a decision about the diagnostic tool. Imagine what it is like waiting. Imagine having to make that decision.

Let me highlight the pressure that women are under by talking about Francesca. Francesca was referred for a hysteroscopy after experiencing heavy bleeding, but the procedure was so painful that she asked the consultant to stop halfway through. These stories go on and on in the same vein—women begging for procedures to stop and being ignored. In that instance, shamefully, the consultant made light of Francesca’s discomfort, making her believe that she was making a fuss about nothing.

As it turned out, Francesca had pre-cancerous cells in the lining of her womb, and she required a follow-up procedure. This time, she insisted that she was given a general anaesthetic. The consultant’s response to that totally reasonable request made Francesca believe that she was asking for the impossible. The consultant warned Francesca that delaying her appointment could increase her risk. Francesca knew—we all know—that leaving cancerous cells untreated is truly dangerous, and having asked for pain relief from the chronically underfunded NHS, she believed that she was guilty of asking for something that she could not and should not have. She felt belittled and bullied, and she was terrified, so she gave in and agreed to have the procedure without the pain relief that she needed. That is so obviously wrong.

Women should not have to choose between their basic right not to suffer avoidable pain and their right to decent, prompt and respectful treatment from our NHS. They should have an anaesthetist there and a range of effective anaesthetics, so that the women are given a real choice. I beg this Government finally to understand that that cannot go on any longer. The NHS needs to be funded to create the capacity, so that women get the treatment they need in time and free from pain. They need to be treated with dignity because, frankly, what is the point of the Government’s women’s health strategy if it cannot even do that?

--- Later in debate ---

[Edward Argar]

I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.

[Ms Brown]

I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.

[Edward Argar]

I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.

In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.

More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.

That will hugely increase the capacity in the system. However—this also relates to the point made by the hon. Member for West Ham—one of the aims of the elective recovery plan, My Planned Care, and similar, is to increase, not just in the space of gynaecological services but more broadly, the opportunities for patients to exercise choice over whether they want something immediately or would prefer to wait, and potentially where they would prefer to have that procedure performed. We are continuing, through this, to try to build in more choice, not just for the patients—although that is crucial—but to help maximise the capacity within the system, to help avoid people having to wait longer than necessary.

[Ms Brown]

What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?

[Edward Argar]

The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.