NHS Hysteroscopy Treatment

Rushanara Ali Excerpts

Thursday 24th September 2020 Commons Chamber

[Ms Brown]

The hon. Gentleman is absolutely right. It is a delight to see him in his place, too. I will come to the lack of pain relief for women and just how damaging that can be for them, not only in that moment but often for their ongoing healthcare, because it creates fear and a barrier.

Massively improved information leaflets have been produced by the Royal College of Obstetricians and Gynaecologists, in collaboration with patients. I am also pleased to note that the NHS website, which I quoted from in the last debate, has now been changed to recognise that some women experience severe pain and a general anaesthetic should be an option. However, many women having a hysteroscopy are still not being given this essential information. They still are not having the risk of severe pain discussed with them properly, and they still are not having the option of a more effective anaesthetic offered freely. In truth, these women cannot give genuinely informed consent, and therefore their rights as patients are being violated.

Telling the story of your trauma is very difficult. The excellent women at the Campaign Against Painful Hysteroscopy are still a relatively small group. Despite that, the campaign has collected 1,500 personal accounts of painful hysteroscopy. Previously in this House, I have told the stories of women who have been held down as they tried to stop the procedure, who have collapsed from shock, bleeding in hospital car parks afterwards, and who have been criticised by doctors for their supposedly low pain thresholds because apparently “most women are fine with it”. Today I will raise the voices of three very recent hysteroscopy patients, because I want the Minister to know that this barbarism is still taking place.

Rebecca had a hysteroscopy last year. She was given no information before her appointment, received no warnings about severe pain and was not offered sedation. Fortunately, Rebecca had had a similar painful procedure before, so she asked for pain relief and was offered a local anaesthetic injected into her cervix. That, in itself, was painful, but she hoped beyond hope that it would be worth it, and the doctor reassured her that the procedure had been massively improved. Instead, Rebecca said:

“As the probe was inserted I struggled to believe how severe that pain was. As the biopsies were taken… I could feel my insides being cut away and I had absolutely NOTHING to address the agony of it all! I was trying not to scream, very close to vomiting and fainting. In trying to contain my screams I couldn’t speak—if I had, the screams would have ‘escaped’ and I knew that they would be deafening. The procedure seemed to go on and on. It was barbaric and, as I hadn’t been given any warning, I felt panicked and unsafe.”

After they were “finished” with her, in her words, she says that no one cared that she felt faint, was close to tears and was struggling to walk. Rebecca tells me she felt conned, and not treated as a human being but

“an object to cut bits out of”.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

I am grateful to my hon. Friend for highlighting what many women have been suffering in silence. The Minister’s reaction to this is profound. Does my hon. Friend agree that the Government must ensure that the national health service provides proper guidance and instruction to practitioners, so that women do not suffer in the way her constituent did?

[Ms Brown]

The reason I am here tonight is to continue the campaign, because it has been going on for some years. I first spoke about this in an Adjournment debate, and an hon. Gentleman I know who sat on the Front Bench took it back to the Department of Health. This campaign has gone on for quite a long time.

Let me tell the House about Vidya. Vidya had a terrible experience with hysteroscopy earlier this year. Vidya has had a vaginal birth. She has experienced that pain, but when the camera was inserted into her womb, Vidya felt such agony that she was not even able to tell the doctor to stop. Like Rebecca, she simply could not scream out. Vidya had not been asked to sign an informed consent form. She was not asked about the level of pain she was experiencing at any time. She said:

“I can’t eat, I can’t go out, I cannot stop reliving the agony in my mind. If I sleep I wake up with terrifying nightmares. I can’t stop crying.”

Like so many of the women who have had to go through this, Vidya has lost trust in healthcare professionals and in our NHS, and I think she is likely to have post-traumatic stress disorder.

I would also like to talk about Alison. She was completely unaware that she was going to have a hysteroscopy until she arrived at the hospital. She had not been sent a leaflet or told anything to prepare her. She had not even had a paracetamol. She said:

“The pain was like I had been thrown into full-on labour contractions. I was crying and screaming out…panting…my heart was racing. The pain was off the scale. After I left the hospital crying in my sister’s arms, she had to help me to the car. I cried solid for 14 hours. This will stay with me the rest of my life.”

Alison’s hysteroscopy took place last Wednesday. These violations of patient dignity and rights are still happening regularly, seven years on. They have to be stopped. I would be happy to send the survey to the Minister, as I have done with previous Ministers, and I hope she will find the time to read through the accounts herself.

Personal experiences are the most important thing here, but there is also new scientific evidence. On 14 September this year, the British Journal of Anaesthesia published an analysis of eight years of data on hysteroscopy outpatients. It found that 18% of patients reported pain at a level of seven or more out of 10, and only 8% reported no pain. Almost 40% of patients were given no pain relief and only 2% were given a local anaesthetic. The doctors and their patients reported back. The clinicians’ judgments about pain seemed to be the very opposite of what their patients actually felt. The doctors who had given an anaesthetic, even a low dose, reported observing very little pain. Sadly, they were not seeing the reality of their patients’ experience. Their patients reported feeling pain when the doctors said there was none. The study suggests that the doctors are, frankly, terrible at judging the extent of the pain of the women in front of them. It also suggests that local anaesthetics are not enough for many women.

We know that our NHS is overwhelmed by covid. We all understand the pressure that the NHS and the Department of Health and Social Care are under. I also understand the pressure that Ministers must be under, but I hope that the Minister will commit, like the last Minister, to taking forward this issue quickly to ensure that the necessary change happens. In January, I asked if pain during hysteroscopy could be included on the agenda of the women’s health taskforce of England. I was told that the taskforce would be open to it, but then came covid. So can the Minister tell me whether the taskforce has met since January? Has it discussed the issue of suffering during hysteroscopy? If not, will she commit to including it when the taskforce next meets?

Also in January, I followed up the most fundamental changes that I think we need to see. The NHS is currently actively encouraging hospitals to perform hysteroscopies as outpatient procedures, with no possibility of a general anaesthetic or other sedation, through the ironically named NHS best practice tariff. Due to the tariff, an NHS manager’s trust will lose money if it provides a general anaesthetic. I have raised the problem of the best practice tariff several times now. Last year, I sent submissions to the utterly opaque and unaccountable consultation conducted by NHS Improvement—also ironic. Like many women of the campaign, I did not even receive a proper response. That is simply a disgrace. Women must not be ignored. We must see the change we seek.

In my last debate in December 2018, I had four straightforward asks. Sadly, they are still relevant today. I want to see: better information to enable informed consent; improved training, especially on the risk factors and forms of pain relief that doctors are trained to offer; every trust properly funded for the most effective and necessary forms of anaesthetic appropriate to hysteroscopy patients; and, finally, permanent removal of the perverse financial incentive that puts more women at risk of trauma. I hope the Minister will tell us about what action the Government might take on each of those.

Every time I have raised the experiences of the many women who have suffered as a result of hysteroscopy, I have had a genuinely sympathetic response. I genuinely believed that the former Minister, the hon. Member for Thurrock (Jackie Doyle-Price), was taking forward our case within Government, but the work she started did not seem to be allowed to come to fruition. I have to ask why.

If women’s health, informed consent and patient safety are genuine priorities for the Government, I hope to leave today with genuine optimism and renewed confidence that, with the new Minister, our campaign will finally have its success. We cannot be satisfied with sympathy—it is not enough. We need action. The Government must finally bring this sorry state of affairs to a conclusion so that women can be assured that, if they need a hysteroscopy on the NHS, they will be in safe, caring and sensitive hands.