NHS Hysteroscopy Treatment

Rachael Maskell Excerpts

Tuesday 31st January 2023 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Mark. I thank all hon. Members for their powerful contributions.

Jan was not one to make a fuss and had never written to her MP before. The fact that she felt impelled to do so is testament to how awful her hysteroscopy was; it motivated her to do everything in her power to prevent other women from suffering the same trauma, despite facing the prospect of terminal cancer herself. Jan sadly died two years ago this week. Her husband came to my surgery last autumn and asked me to take up this work, informing me of the work my hon. Friend the Member for West Ham (Ms Brown) was pursuing. Knowing her as I do, I know that she will do everything possible to speak up for women and ensure they are heard.

It was 16 November 2020. My constituent was terrified. She had discussed the process with her medical friend, who advised her to tell clinicians on arrival. She did, but was met with derision and disdain. The official guidance says:

“If you feel anxious about the procedure, you should talk to your healthcare professional before your appointment.”

She wished she had not. My constituent was there for an examination of a possible cancer of the uterus. She was naturally very concerned. She did not want to have to delay a diagnosis for the sake of waiting for a general anaesthetic. She was not informed that she could have a general anaesthetic; it was just her own research that took her to that place. She was told that it could be another two to four-week wait. As we later found out, that would have been a significant period of the rest of her life.

Jan went ahead but nothing prepared her for the pain she was about to experience. She had had no pain like it. Even having given birth vaginally three times with little or no pain relief, she could not comprehend the pain that she was about to experience. The clinician did not stop and did not seek to know her pain level until she was in so much pain that she could not speak. She was trying not to pass out; she was trying to stay conscious. When she was asked, she could not respond. I must say that when I heard the story from her husband, I sat there thinking, “This is assault.” There was no informed consent.

As we know, a third of women experience significant pain in this procedure, although research is poor. Options are not clearly communicated to women and women’s voices are simply not heard. If a third of women are experiencing significant pain, that means the majority are experiencing some level of pain. It is beyond my comprehension why women have to experience pain at all. As we have seen in the “First Do No Harm” report, which many have raised today, the voices of women in healthcare are simply not being heard. We can all reflect on our own experiences of being dismissed—that it is nothing and there are clearly other more important things to deal with. It is simply not good enough. A woman’s voice is disappearing in our health service; it needs to come to the fore and today’s debate will do that.

That was not the end of the story. We sought a review of the case and the department lead carried one out. The review said that there was consultation and listening, but that was a very different story from Jan’s experience. Ultimately, the outcome did not change the situation, but women will be going through that process every day, and we therefore have to change the situation all together.

We have a women’s health strategy. We need to ensure that the woman’s voice is heard in our NHS, because Jan’s was not. Constant verbal feedback is so important when going through any procedure. A clinician should be constantly looking, watching, seeing and understanding their patient. That clearly did not occur. Of course, the clinician should have stopped, but they never should have started. It never should have got to that point.

The way in which patients are counselled for this process needs to be completely re-examined. Having a general anaesthetic should not just be posed as an option, but perhaps be suggested as the most pain-free way of having the procedure. There are other things available, for instance a local or regional anaesthetic, or—if a woman dares or is ill-advised—just an analgesic, but we should focus on ensuring that this is a pain-free procedure for women. But that is not what is advised; that is not the target. It is a target that is driving this experience as well, and it must be removed all together.

Like many areas of women’s health, this is a massively under-researched area of medicine. Can the Minister commission research into hysteroscopies, particularly in post-menopausal women? A doctor came to see me to talk about how the cervix changes as people get older. It can cause tightening, meaning the procedure is even more difficult for older women. Therefore, carrying out proper research to understand the changes within the body would seem completely appropriate before the procedure continues, particularly for older women.

In conclusion, we have talked about the need for women to be heard in the health service, but we need to gather that. I hear about the work that is being undertaken, but as we were saying in response to the “First Do No Harm” report, there should be proper logging of who has been through this procedure. We should seek out that voice, because we may see a different reflection of what has happened. In Jan’s words, the experience left her “deceived, patronised and betrayed”. That is simply not good enough for our NHS.

--- Later in debate ---

[Maria Caulfield]

I very much take the hon. Lady’s point. The change to RCOG guidance is not the only way we will change this. The hon. Member for Strangford (Jim Shannon) highlighted his wife’s experience, which also shows why this is so important. The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice. Its current guidance already sets out that a leaflet should be provided with information about what a hysteroscopy is, what happens, and what the possible risks and alternatives are, but that does not always happen. Women can choose whether to have their hysteroscopy in an outpatient setting or have a general anaesthetic and come in as a day case. They do not always get that leaflet now, so just changing the guidance does not necessarily mean that we change the practice, and that is the key.

It is important that women are in control when it comes to hysteroscopies, which we are talking about today, and many other issues that we have debated. That is the fundamental principle behind the women’s health strategy, which we introduced because women are very often not listened to in all aspects of their healthcare.

The hon. Member for Enfield North touched on the top priorities for the first year of the women’s health strategy. The reason that hysteroscopy did not make that list is that we want to wait for the guidance before we act, but it will be a high priority, and work is starting this year.

One of the key priorities is to provide better information to women and girls about their health. We are setting up a space on the NHS website for women’s health so that women who are going for a procedure have go-to information. If they are thinking, “I don’t know what a hysteroscopy is. I don’t know what sort of tests I need. I am going for an ultrasound, but what else might they suggest to me while I am there?” they can go to that site and get reliable information that will help them make that decision. If they are not sent a leaflet and the procedure is not discussed in the clinic, they will be able to know in advance what to expect. We want that to happen this year so that women have more power when making decisions about their healthcare needs.

Waiting times for gynae procedures have not come up much today, but we know that the covid pandemic has had an impact on them. Gynae procedures are part of the elective recovery plan, which is why we are investing in community diagnostic centres to get those waiting lists down as quickly as possible. It is hoped that by having specialist centres such as community diagnostic centres, which are specialists in doing diagnostic tests, we may be able to improve women’s experience.

One of the things that will make the greatest difference is the appointment of Professor Dame Lesley Regan as the first women’s health ambassador—my hon. Friend the Member for Thurrock mentioned her. She is a female gynaecologist, and she completely gets the issues facing women. We also now have the patient safety commissioner, Dr Henrietta Hughes, who was appointed last year. She is a female GP. Dame Lesley has been passionate about this issue for many years and has been working with women’s groups on it. I have asked her and Dr Hughes to discuss hysteroscopies. They are planning a roundtable on the issue to get stakeholders round the table to discuss how we can make things happen in practice. If guidance is issued, how do we make sure that is what is happening on the ground? The roundtable will be chaired by Dame Lesley, and the patient safety commissioner will be attending. I will update Members on their recommendations, which I will take extremely seriously, and I will want to implement them as quickly as possible.

[Rachael Maskell]

I am grateful for the Minister’s response. Will she include women from ethnic minority groups? Their experience of the health system is very different, so it is really important that their voices are heard in this discussion.

[Maria Caulfield]

Absolutely. Dame Lesley has been very keen in some of her first work to ensure that we go out to women, rather than expecting women to come to us with their experiences. Often, if we wait for them to come to us, it is the usual voices that get heard. The people who have the greatest difficulties accessing healthcare are often the ones who get missed, so I can absolutely reassure the hon. Lady about that.

That is why we are setting up women’s health hubs, which are a particular priority of the women’s health ambassador. They are go-to one-stop shops that have experienced women’s healthcare professionals. If someone is going for a smear test, contraceptive advice or perhaps a hysteroscopy, there are experienced practitioners there who can support women’s health needs and perhaps give a better experience than many women have now. We hope to improve women’s experience in those areas.

I say to the hon. Member for West Ham that I absolutely recognise the significance of this issue. It is unacceptable that a test that is so important for women’s health is currently such a painful experience. We changed the tariff in the hope that it would encourage the use of general anaesthetics if that is what women want, because we felt that the previous tariff system worked against that. However, I am really keen that we deliver changes on the ground once we get the royal college guidelines and the roundtable with Professor Dame Lesley Regan and the Patient Safety Commissioner, who are there to advocate for women and patients. I hope that will be within the next few months, and I am happy to meet the hon. Member for West Ham, as I will be meeting the patient campaign groups too.

We can change this behaviour. A woman who is having a hysteroscopy should know in advance what is involved and what her choices are. She should feel confident that if she turns up for her appointment and finds it uncomfortable, which she was not expecting, the procedure can be halted and a separate appointment can be made swiftly to make sure that the procedure is as comfortable as possible. I hope that gives some reassurances that I absolutely take the seriousness of this issue on board, and that we want to make a change and a difference for women.