NHS Hysteroscopy Treatment

Debate between Lyn Brown and Baroness Keeley

Tuesday 31st January 2023 Westminster Hall

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

I beg to move,

That this House has considered the matter of NHS hysteroscopy treatment.

It is an absolute pleasure to serve under your chairship, Sir Mark. I am particularly glad to be joined in this debate by hon. Friends and by the hon. Member for Thurrock (Jackie Doyle-Price). When she was responsible for women’s health, she took this issue seriously. We had a number of highly productive meetings about it, so it is welcome that we have the benefit of her ministerial experience in the debate.

This is the 10th time that I have spoken in this House about the completely unnecessary pain and trauma that women are subject to when they undergo hysteroscopies. Women who need pain relief are simply not being given it. They are being patronised, belittled and, frankly, betrayed. Effectively, they are bullied into accepting treatment so painful and damaging that they would never have agreed to it had they known what was coming.

I first spoke about how this issue needed to be resolved 10 years ago, at the behest of a constituent who came to my surgery to talk to me about her experience. Frankly, I am horrified that precious little seems to have changed since then. I will share a few of the recent stories that women have sent me since the last time I spoke about hysteroscopies in this place. I have had to choose very carefully: the number of women who have written to me is large, but my time this afternoon is short.

Julie had a hysteroscopy in July last year. She is 71 years old and wears hearing aids. Julie thought she was going in to see a gynaecologist and perhaps to have an ultrasound to investigate unexpected bleeding. She had been given no additional information, despite having waited for that emergency appointment for six long months. I can imagine how frightened she was. As expected, Julie’s appointment started with an ultrasound; unfortunately, the scan showed some thickening in the lining of her womb. Julie had removed her hearing aids to avoid losing them, which had happened before, so she could not clearly hear what was being suggested, but she was told that another procedure was necessary. A different nurse came in, and that was the very first time that Julie heard the word “hysteroscopy.”

Julie was, of course, a little confused about what was happening, because she could not hear properly, but she managed to make out that she might feel some mild cramping as the fluid and the scope were inserted. However, she describes the pain as utterly excruciating. The nurse tried to talk her through it and take her through breathing exercises, but they did no good—how could they? Julie was in a clammy sweat; she was worried that she would pass out. She was asked whether they could continue, and she was so worried about the ultrasound findings, and the last six months’ wait, that she said they could. A second attempt was made. Julie simply could not hold back her tears, or even breathe, through the terrible pain. Thankfully, the nurse asked again whether the procedure could stop, and Julie could say nothing but yes.

Afterwards, Julie was terribly woozy. She was wobbly, and scared that she would faint and fall. She was well cared for at that point—given pads for the bleeding and hot packs to help with the severe abdominal cramping. She lay in the recovery suite for about an hour, crying. Even after that, she was disassociated, trembling and struggling to walk. I remind hon. Members that she is 71 years old. She is truly lucky that she did not fall and break something.

Another woman who wrote to me was so overwhelmed by the pain of her hysteroscopy without pain relief that she fainted and fell from the full height of the operating bench to the floor. After that, she was left with not just serious bruises but lasting dizziness that has led to repeated falls and broken bones. It has physically affected her so badly that she has found it hard to stay in work for the very first time in her life.

In some ways, Julie was lucky, but the lasting impact on her was still significant. She vomited, and when she got home she continued to bleed for more than a week afterwards. She describes herself as stoic. She has had several surgeries before, and she lives with serious arthritis, so she is no stranger to pain. In her words, what she went through was “a brutal, torturous experience”.

The shameful truth is that at no point was Julie offered any form of pain relief at all. She only heard that a hysteroscopy was even a possibility while lying on the examination table with her legs up in stirrups. It is frankly a miracle that she was not so traumatised as to lose trust completely in the NHS, but she has since been back. She has had another hysteroscopy under general anaesthetic and found it an utterly different experience. All the procedures and risks were explained beforehand, and she had outstanding care throughout.

While Julie was in the waiting room for the second, successful hysteroscopy—this points to how commonplace this experience is—she met another woman whose experience was just like hers. The other patient was just as upset, but said she would not make a complaint because she felt she would just be ignored, and that would make her even more stressed. Sadly and understandably, most people who have had similar terrible experiences with the procedure are like the woman Julie met. We never hear their stories.

Let me offer some more testimonies to give voice to those whose pain and distress were completely ignored. Martha was seriously injured during her hysteroscopy last August. She went in for a check-up after she had bleeding for several days after starting hormone replacement therapy. Her GP referred her for the hysteroscopy, but although he explained some of what the procedure would involve, he was, in Martha’s words, “blasé”. He showed absolutely no understanding that Martha’s medical history and conditions made extreme pain and damage much more likely. When the procedure began, Martha described the pain as “excruciating”—exactly the same word that Julie used.

Martha screamed out, “No, no, stop,” repeatedly, yet when the doctor looked at her, he looked very unimpressed. He asked her whether she would rather he stopped so she could come back and have it under general anaesthetic. She said yes, but instead of listening, he insisted that he have more time—just 30 seconds. He went in again with a smaller scope, but again it caused searing pain.

After the procedure, Martha understandably felt violated, but sadly that was far from the end of her ordeal. She had burning pain for weeks, mixed with a loss of feeling in her groin. She developed repeated bladder infections and double incontinence, and her muscles started wasting. She had difficulty standing and walking. Eventually, Martha was told that she had post-operative nerve damage. To put the cherry on the cake, I understand that the doctor who did this to Martha recorded her pain score as just one out of 10. To me, this sounds very much like fraud—on top of sheer callousness, absolute incompetence and indifference.

Martha describes herself as a fiercely independent woman who does not suffer fools, but she told me she had the overwhelming feeling she had been duped and made a fool of. She says she has always trusted professionals, but never, ever again. She is reeling because the NHS that she supported for decades

“managed to injure me and cripple my life, take my self-respect and my confidence in under 15 minutes.”

Martha tells me—I think she might be right—that the next great women’s health scandal after mesh implants will be this.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am really appalled, and I want to raise a point with my hon. Friend. The situation Martha found herself in is happening up and down the country. A constituent who was due to have a hysteroscopy examination at our local hospital in Salford was told the same thing as in the stories my hon. Friend is telling: “Local anaesthesia can be given if necessary” and “Take paracetamol one hour before.” However, this constituent had a family member who had had a hysteroscopy in a private hospital and was offered a general anaesthetic because the procedure was “too painful” to be performed in any other way. So the NHS patient in a private hospital is offered a general anaesthetic, but the one in an NHS hospital is not. When I wrote to the hospital on my constituent’s behalf, I was told:

“a general anaesthetic can be requested, though the medical team advise against it.”

There is a key question that I want to put to my hon. Friend. It is all right to say that the procedure can be stopped or carried out later, but does she believe that the information given to patients is wrong and that that is not acceptable care?

[Sir Mark Hendrick (in the Chair)]

Order. Can I ask that, when hon. Members intervene, they make it short?

Apprenticeships and Skills (Public Procurement Contracts) Bill

Debate between Lyn Brown and Baroness Keeley

Friday 1st November 2013 Commons Chamber

[Lyn Brown]

I absolutely do think it is important that we are working with jobcentres. In Newham we have an excellent programme called Workplace, in which local employers work with the local council and Jobcentre Plus to advertise local positions locally before they are advertised regionally or nationally. That can only be a good thing in an area with the deprivation indices that we have. It is one way of embedding into the area an economic and social legacy for the people that I represent.

The other good thing about what the LLDC is doing is that it adds value and avoids duplication with the existing employment and skills provision of the London boroughs. We are not talking about something that becomes unwieldy, or that is not welcomed by the other host boroughs. When we are recreating infrastructure and targeting delivery according to the needs of the park, we ensure that it is done in the most cost-effective way.

The LLDC is tailoring its approach to the specific needs of the contracts in the programme. We are not asking employers to take on apprenticeships and to have apprenticeships that are not consistent with what they are contracted to undertake. That is another good thing. The Bill would not require the LLDC to change its modus operandi at all; it gives a platform on which the LLDC can base its apprenticeship programme. Obviously, it promotes best practice in recruitment and promotes the London living wage or the construction working board agreements—whichever is higher. I am sure that every Member in the Chamber would applaud that.

There is a strong client commitment to delivering jobs and apprenticeships, which means ensuring that these elements are sufficiently weighted in the pre-qualification questionnaire and invitation-to-tender evaluations. The Bill sends an important message to bidders about the importance of this agenda to the LLDC. The need for apprenticeships is there. It is in the pre-qualification questionnaire. If you want to—I am sorry, Madam Deputy Speaker; I know that you will not want to qualify as a contractor at the LLDC, although you could should you wish to, of course.

Any company that wishes to qualify to take a contract with the LLDC has to submit a completed questionnaire. One of the questions in it is, “Are you prepared to offer apprenticeships?” If the company is not prepared to do so, it might get a bit cross. It might think to itself, “Why should I have to?” The Bill will point to the fact that the LLDC is entitled to place that requirement in its pre-tender questionnaire.

The LLDC makes sure that contractors are aware of everything in its procurement pipeline, and uses the principle of relevancy to identify appropriate evaluation questions and weighting. Externally, the LLDC ensures that bidders are clear about the regeneration aims and objectives of the LLDC—convergence and so on. I know that we all understand what that means.

Crucially, the LLDC provides contractors with enough information to know what kind of commitment they are making. It specifies the commitment that companies will have to make in order to get the contract. It is clear that companies will be monitored, evaluated and held to account for what they deliver or fail to deliver. The Bill will make sure that those companies understand that the LLDC is not asking anything of them that it is not entitled to do.

The LLDC asks bidders to set targets for apprenticeships for under-represented groups such as black and minority ethnic communities, disabled people, previously unemployed people, people who have been unemployed for a very long time, and women. I hope you do not mind, Madam Deputy Speaker, if I digress for a moment and say that one of the things that I liked about the apprenticeship programme for the building of the Olympic sites was how it encouraged women into construction industries.

One of the things I learned from sitting in a digger truck and trying to excavate the earth at the Olympic park was that employers liked women using their equipment, because we are gentler on it and the equipment lasts longer if women are employed to use it. I know this from my own experience of driving a car and using the clutch, but my husband disagrees somewhat.

[Barbara Keeley]

Earlier I mentioned City West in Salford, which takes on apprentices. Those apprentices usually appear at city festivals, where I saw the best example I have ever seen of somebody plastering. That left me, and probably left that woman too, with the view that plastering is not something I will ever be good at. She persuaded me to try it. She was an excellent woman plastering apprentice, but this MP is not going that way.

[Lyn Brown]

I am not very good at icing cakes either.

--- Later in debate ---

[Barbara Keeley]

I want to return to my hon. Friend’s earlier point about young women. There is a question about young people moving on to permanent jobs. I do not know whether my hon. Friend is aware of it, but a report out today states that three times more young women are employed in low-paid, low-skilled jobs. The proportion of the group about whom we are worried, the 16-to-24 year-olds, in jobs such as cleaning offices and hotels—of which there are plenty in the area of London my hon. Friend is talking about—has increased from 7% to 21%. Sadly, only 1% of the young women are working in skilled trades, compared with 20% of the young men.

Is there anything in the regeneration around the Olympic park that gives hope that those young women will not carry on in those unskilled trades of cleaning offices and hotels, but get opportunities through apprenticeships to do something more skilled?

[Lyn Brown]

I am happy to tell my hon. Friend that the LLDC has reported that its targets for BME communities, women and people who have been unemployed for a long period have all been met. It did say that employment for disabled people had been slightly under target, mainly due to non-declaration at the point of induction; people are not recorded as disabled in an apprenticeship because they do not self-identify at the point of application. The LLDC has done a sterling job.

High Cost Credit Bill

Debate between Lyn Brown and Baroness Keeley

Friday 12th July 2013 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am pleased that there is a little time left for me to speak. I pay tribute to my hon. Friend the Member for Sheffield Central (Paul Blomfield) for introducing a Bill that addresses a number of serious issues in respect of payday loans. It is clear from today’s debate that such loans are of concern to many hon. Members.

The Bill is important because, as my hon. Friend the Member for Glasgow North (Ann McKechin) said, we have a weak regulatory system for high-cost credit. Citizens Advice tells us that self-regulation of the payday loans sector has not worked. Since the introduction of the industry’s good practice customer charter in November 2012, Citizens Advice has run a survey to help people who have payday loans check whether their lender is sticking to the charter. The results show that the charter is not being met to a surprising degree. Payday lenders are failing to treat people fairly and are breaking 12 of the 14 promises laid out in the charter.

The Citizens Advice survey also shows that lenders are not making adequate affordability checks. I am glad that that problem has been referred to repeatedly in this debate. There are many examples of customers who get into financial difficulty not getting the help that they need. Some even find that the lenders, rather than helping them, are positively obstructive to their attempts to pay off their debts.

My hon. Friend the Member for North Durham (Mr Jones) talked about the millions of pounds that are being made in the payday loans market. That market is growing very quickly. In 2008-09, it was worth an estimated £900 million. Last year, it was worth between £2 billion and £2.2 billion. That big increase is a sign of the growing hardship in our communities.

I welcome the measures in the Bill to deal with the serious pitfalls that are experienced by large numbers of borrowers, which we have heard about today. It would deal with opaque interest charges, the use of continuous payment authorities to collect repayments regardless of the borrower’s financial circumstances and the key issue of advertising, which we have talked about. Young and vulnerable people are bombarded with a saturation level of adverts and texts promoting payday loans.

[Lyn Brown]

I was going to say more in my speech, but I wanted to keep it short so that my hon. Friend and others could get in before the end of the debate. I was going to speak about those pernicious television adverts with the little old puppets who wander around. They just look so cosy. In fact, one of the young people who came to see me because they had difficulty with payday loans did not go to Wonga because it was for old people. Does my hon. Friend agree that the advertising targets vulnerable groups in our constituencies?

[Barbara Keeley]

It does target such groups, and those cartoon characters are pernicious, as is the use of celebrities, some of whom should be ashamed of endorsing such products and bringing misery into people’s lives.

The Bill provides that the Financial Conduct Authority shall have power to introduce an additional levy on lenders to fund a debt advice service, which is good. We have heard repeatedly in this debate about the misery that payday lenders are causing people, and it is right that they should fund debt advice services. Such services should be an integral part of the lending process, but that need is too often ignored. Given the profits and growth in the market that I outlined, it is only right for the high-cost credit sector to help with a levy to pay for debt advice services.

Citizens advice bureaux up and down the country are struggling with cuts to their grants from local authorities. I felt the need to enter a 10 km race, which I ran on behalf of my local citizens advice bureau. It was not the sort of help that Front-Bench colleagues can sometimes raise, but I thought it important for those at my local citizens advice bureau to understand that I was prepared to do something to help with funding. The funding of advice services is crucial.

I have three broad concerns about the way the payday loans industry works. The first, which we have heard much about, is the issuing of multiple loans, which is one of the biggest causes of defaulting on the repayment of a loan. Many examples have been provided by the StepChange Debt Charity, which reminds us that findings by the Office of Fair Trading highlighted widespread irresponsible lending. In particular, the scale of repayment problems shows us that such lending is not confined to a small group of rogue lenders.

In 2011-12, about 2.7 million loans—one third of the total—could not be repaid on time, or at all. That is serious, and plainly highlights the issue of affordability. Nearly two thirds of those seeking help with their debt from StepChange have more than one loan, and nearly one third have four or more. In Salford, a person who works at a college on the minimum wage told Salfordonline, a local community website, that she had taken out loans to pay both her rent and council tax—an example of using loans for everyday living costs similar to that presented by my hon. Friend the Member for West Ham (Lyn Brown).

That person said:

“I have poor credit so I went to Wonga, then I got into a mess with interest so I got other loans. At first it was £150, then £300, then I just started paying the interest. Then I got other loans to cover my living expenses, it was out of control and I was missing payments.”

She was finally forced to call in a debt management company, but that, too, was “for a fee”, making her problems worse.

A request for more than one loan should ring alarm bells about the applicant’s financial circumstances and their ability to pay, but no alarm bells appear to be in place in the officers of these lenders. We need tighter controls to ensure that requests for more than one loan trigger comprehensive debt advice, and a repayment plan with a proper assessment of a person’s ability to pay.

We have heard much in this debate—quite rightly—about the volume of roll-over loans where loans are renewed at the end of an initial loan’s repayment period. That business is increasing, and few mechanisms are in place to assess properly the ability of borrowers to repay.

The Office of Fair Trading states that three quarters of payday lenders—a substantial part of the market—are renewing loans without checking whether they will be affordable, even though a roll-over is a clear warning sign that a borrower might be experiencing financial difficulties. The OFT notes that payday lenders have a strong incentive to roll over loans as they make half their revenues that way. I welcome the provisions in the Bill that empower the Financial Conduct Authority to set limits on charges, including interest, and to restrict the ability of lenders to make multiple and roll-over loans.

StepChange tells us that since 2011 the average amount owed in payday loans has increased substantially by £400 to £1,665. On average, people now owe more than a month’s income in payday loans. Average monthly income is now £1,298, and the average owed in payday loans is £1,665. That is a key measure of lack of affordability. Sadly, in my constituency the average owed on payday loans is £1,673, which is even higher than the national average.

As my hon. Friend the Member for Sheffield Central detailed earlier, there is serious concern about how the industry uses and misuses the continuous payment authority. Many hon. Members will have heard about constituents —we have heard some examples today—who are trapped in a cycle of debt that is made worse when the lender uses the continuous payment authority to take money out of their accounts, regardless of the impact on the borrower. As we have heard, money is often withdrawn by the lender with no consideration for the borrower’s essential living costs. Indeed, an example given today by Salford’s citizens advice bureau is of a borrower who fears he will lose his home and his job because payday lenders have left him with only £1.17 a week from his weekly wage. He does not have enough money to travel to work, let alone pay for his other living costs.

[Lyn Brown]

One of the things that has come up in my surgeries time and time again is how telephone calls and letters from lenders imply to borrowers that their debt to a payday loan company is a priority debt. There is no explanation that the real priority is to keep a roof over their head: paying the mortgage or the rent, and the council tax. Does my hon. Friend have similar examples?

[Barbara Keeley]

Indeed. One difficulty is that the banks are not straightforward enough with their customers. I strongly support greater controls over the use of the continuous payment authority. People have to be allowed, however much or little income they have, to plan their own finances.

We know from all these examples, and the example cited by my hon. Friend, that not enough borrowers know that they have the right to ask their bank to cancel the continuous payment authority. The Bill gives the FCA the power to require lenders to provide information about the right to cancel from the outset of the loan. This would give people who took out payday loans additional peace of mind that if they got in a mess and things were not working out they could cancel it.

The third area of concern, returning to the point made by my hon. Friend, is the persistent and excessive advertising of payday loans. Citizens Advice tells us that advertising for payday loans has reached saturation point. The adverts are unclear on costs and the potential impact of failure to repay a loan. Also worrying is the use of celebrities and cartoon characters in adverts. How are we targeting a market of responsible borrowing and lending by using cartoon characters? Clearly, young families and vulnerable people are being targeted with blanket advertising on daytime television. It is when I exercise in the gym that I am confronted by this constant advertising, and I find myself wanting to turn away because I get so sick of seeing it. One 32-year-old worker told Salfordonline that he had used Wonga to take out eight short-term loans in one year. He said:

“I was working but needed a little extra cash to help out at home”.

He had used overdrafts and credit cards before but:

“The most recent loan of £200 was taken out over four weeks, with £260 to pay back. I was tempted because it’s so easy to borrow and all the adverts on TV don’t help. The fact that there are no credit checks helps a lot of people into bad financial situations.”

Citizens Advice feels that broadcast advertising for payday loans should be limited to after the 9 o’clock watershed, and should be prohibited from any programme likely to appeal to anyone under the age of 18. It also feels that the measures in the Bill are needed to stop marketing via text messages. The 32-year-old from Salford whom I just quoted highlighted the fact that payday lenders would hold on to his details for six years, and that he was expecting to be bombarded with e-mails and texts offering him more loans. He commented:

“I won’t be using”—

payday loans—

“again, but I wish I could just close down the account so there is no temptation. Once they get their teeth into you they never let you go.”

This morning, Paul Lewis’s money website raised the issue of payday lender QuickQuid, which yesterday sent lots of e-mails to people on its database. They might have been QuickQuid customers who had already paid off their loan, but they seemed to include people who had never paid it back. We have discussed the point about bailiffs; these threatening e-mails warned that action would be taken if the customers did not pay back the debt and that debt collectors would be sent in. It caused great alarm.

Research for Which? found that seven out of 10 payday loan users regretted taking out credit and that half had taken out credit they could not repay. Citizens Advice believes that the Bill would be a key step towards protecting people from some of the worst practices of payday lenders and help better to protect borrowers struggling to repay debts. I pay tribute to the citizens advice bureau in Salford, which gives great help and advice, and to citizens advice groups across the country. I am sure hon. Members might like to pay tribute to their own CABs.

[Lyn Brown]

I absolutely agree with my hon. Friend. Currently, we have no CAB in Newham, and funding for advice groups is drying up. It has become impossible for people to get the financial advice and assistance they desperately need.

[Barbara Keeley]

I went on a 10 km run to help my CAB; it was under threat, but we managed to preserve this essential service in my locality. Salford city council offered it accommodation, and it now runs an excellent service from a local council building. That has really helped.