NHS Hysteroscopy Treatment

Mark Hendrick Excerpts

Tuesday 31st January 2023 Westminster Hall

[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?

[Ms Brown]

I agree with my hon. Friend that there is a massive lack of information. I am sure there is a difference between private and public health in this area, but a friend of mine went to a London hospital and asked whether she could be given a general anaesthetic. The answer she got was, “Of course. Do you think we’re barbarians?” There is different practice in different NHS hospitals, and a different understanding of the kinds of issues we face.

I think we all know the upshot of these kinds of experiences: women will end up too afraid to get procedures that they need to have. It will impact on their long-term health prognosis. It will cost the NHS more in the future, as it has to play catch-up on diagnosis. As we know, hysteroscopies are really important. They can be used to rule in or out cancer and a host of other important conditions, so women have to be confident about having them. They need to have them, and they need to know that they will not experience what Julie, Martha and so many more women have experienced.

The survey being run by the Campaign Against Painful Hysteroscopy has had over 3,000 responses and counting. Despite that, and despite all the individual stories I receive and raise in Parliament, we simply do not know how widespread the problem is. I am afraid that the reason might be that the NHS really does not want to know, because knowing would strengthen our calls for change and for all women to be treated with respect, to have their pain taken seriously and to be given accurate information and genuine choice. For that to happen, I believe that the Minister has to engage with this issue personally and dig a bit deeper to ensure that accurate and appropriate data is being collected and analysed. We also need independent oversight. I beg the Minister not to be content when, inevitably, the medical profession says, “It’s fine” and “Action is being taken,” because, frankly, it has been 10 years, and we have heard it all before.

I am sure the Minister will remind us about some of the campaign successes, such as scrapping the best practice tariff, which until very recently financially rewarded NHS trusts for doing hysteroscopies in out-patient environments, where proper anaesthetic is not possible. Sadly, that drive for more cheap, quick hysteroscopies, regardless of the risk to women’s health and wellbeing, is still going strong. The target of 90% of hysteroscopies to happen within out-patient rooms has emerged again in a new NHS programme, which, ironically, is entitled “Getting It Right First Time”. I can tell the Minister that if women continue to be pushed into hysteroscopies without proper care, the NHS will not be getting it right first time at all. Instead, more women will endure pain for no reason at all during unsuccessful procedures, and they will then have to repeat those procedures under general anaesthetic.

It appears that the target of 90% is the brainchild and objective of the British Association of Day Surgery—well, I am sure there is no vested interest there. It is frankly alarming that we have a clinical lobby group advocating, effectively, against women having a genuine choice over the pain relief they need when they have a hysteroscopy. What is worse is that I understand that some private companies are promoting their no-anaesthetic out-patient procedures within the NHS by bragging that hospitals can save up to £1,000 per patient. You could not make it up. Clearly, there are some very influential people who do not want this campaign to succeed and who prioritise saving money—or making money—over women’s safety from pain and trauma.

I know how busy the Minister is, but we ain’t going to be successful in our campaign for pain-free hysteroscopies without Government leadership. I was pleased to hear last night that the Minister’s office has contacted the campaign group offering times for a meeting. That is good news. I strongly agree with some of the Minister’s words in response to one of the anonymous women whose cases I have raised today. Let me quote the Minister:

“It is clearly important that women are offered, from the outset and as part of the consent process, the choice of having the procedure performed…under general…anaesthetic.”

I ask the Minister to emphasise that point today, because women cannot give truly informed consent unless they have had a full discussion—including a discussion of their individual risk factors and a choice of anaesthetic—from the very start. In my view, that means that Julie, Martha and so many others have had a surgical procedure performed on them without consent. I am sure we would all agree that that is very serious indeed. When the Minister responds, I hope she will commit to treating this issue as a high priority for women’s health. We do not want women to be bullied when they go into the NHS for treatment.

We are eagerly awaiting the publication of the good practice paper from the Royal College of Obstetricians and Gynaecologists, and other new guidance—I had hoped to have it yesterday in order to inform this debate. I understand that the draft paper recognises that fully one third of women report pain scores of between seven and 10 out of 10. That clearly shows that we need a massive change. The need for real choice cannot just be in guidance; it also needs to be enforced.

Based on the recent stories of women that I have told today, in many cases we are seeing brutality instead of best practice. Women are being violated and betrayed. Their trust in the NHS and medical professions is completely undermined. Surely that cannot be a legacy that the Minister, or the Government, want to leave behind.

[Sir Mark Hendrick (in the Chair)]

Thank you. I remind Members to bob if they wish to speak.