NHS Hysteroscopy Treatment — House of Commons, 2020-09-24
Topic: Health
Nadine Vanessa Dorries (Conservative, Centre-right): Wow. That was certainly a moving Adjournment speech. I thank the hon. Member, who knows she has my respect. We have been here together for many years, and I have to say that I am truly moved—more than moved—by the accounts of Rebecca, Vidya and Alison. Those stories are incredibly impactful because we know they are real and because, as women, we understand exactly what they are relaying in their experiences in a way that—I am sorry—chaps just do not The hon. Member referred to being here eight times. I think I have some good news for her in my response, and that is because she has brought this issue back here eight times. What I am about to say is in no small part due to her persistence. We all know that, in this place, very little happens overnight. The only way we achieve change is by doggedly continuing to push until something happens. I think she will be pleased with what I am about to tell her, but there is also something we will need her and the campaign to do to continue the momentum I thank the hon. Member for her continued campaigning, and I am delighted to respond to the debate. A hysteroscopy can be an essential tool in the diagnosis and treatment of conditions. What she referred to in, I think, Rebecca’s experience was a biopsy that is taken to look at tissues, for various reasons. Hysteroscopies are most important in investigating unexplained and distressing problems—they are a timely diagnosis tool—and can be used as a process for dilation and curettage. There are many reasons why women need them. I am almost loth to read out these words—the hon. Member can tell I am going off script here—but the answer always is, "It’s a very quick procedure, it takes 10 to 15 minutes. If someone is in pain, 15 minutes is a very long time. Who would want to be in labour for 15 minutes? It is a long, long time I am almost tempted to say, "Shall we put our hands up to show who in here has been through a hysteroscopy?", but maybe it is not appropriate for me to say that. I think we all can understand what the experiences are like. Patient experience is significantly varied, so there will be patients who say they did not feel anything and there will be patients who have stories such as those of the people the hon. Member has spoken to The NHS does not collect data on the number of women who experience pain— surprise, surprise—during hysteroscopy. However, I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of hysteroscopy patients have reported pain, and 25% is a considerable number. It is essential that women who are offered a hysteroscopy are given the information that they need to make that informed decision, which must include information about potential pain, options for pain management and alternative procedures that are available, such as a general anaesthetic I will address the points the hon. Member made regarding whether women are being offered appropriate pain relief and her concern that the national tariff—I completely agree with her here—creates an incentive for hysteroscopies to be carried out as an out-patient, without appropriate pain relief for those 25% of women. I will talk about three components to ensuring that women receive the care they deserve: evidence-based clinical guidelines, embedding the patient voice and monitoring implementation To minimise pain and promote best practice in hysteroscopy, it is essential that clinicians have access to guidelines. The Royal College of Obstetricians and Gynaecologists currently has a guideline, produced in 2011, which provides clinicians with evidence-based information regarding out-patient hysteroscopy. The guideline has an explicit focus on minimising pain and optimising the woman’s experience. It makes specific recommendations on practices that help to reduce pain I am told that the RCOG is now developing a second edition of those guidelines to ensure that the recommendations are based on the most up-to-date and robust evidence base. It is being developed jointly with the British Society for Gynaecological Endoscopy, and patient groups are represented on RCOG’s guidelines committee and the development group. Furthermore, a statement from the British Society for Gynaecological Endoscopy, which was published on RCOG’s website in 2018, also emphasises the importance of offering women from the outset the choice of having the procedure performed as a day-case procedure under general or regional anaesthetic as an alternative to an out-patient setting Alongside clinical guidance, I note the importance of patients’ voices, which are critical at every stage of the treatment pathway. Decisions on any treatment, including out-patient hysteroscopy with its benefits and risks, should always be discussed as part of the shared decision making between the clinician and patient. I understand that since the last parliamentary debate on this subject in December 2018, the NHS website, as the hon. Member noted, has been updated. I thank her for pointing it out and enabling that to happen. The website has been updated and RCOG has published a patient information leaflet regarding the procedure NHS England recommends that, as part of good practice, the Royal College of Obstetricians and Gynaecologists’ patient information leaflet, published in 2018, is provided to patients in advance, to assist with obtaining informed consent for the procedure. I imagine by that they mean that it is sent out with the appointment for the procedure or handed out at the clinic The patient information leaflet contains a lot of helpful information for patients. It explains what the procedure is and what is involved, what the patient should do beforehand and the questions they should ask health care professionals, the risks and alternatives, after-effects and what will happen following the procedure. The leaflet also recommends that patients take pain relief one to two hours before the procedure. After a hysteroscopy, I encourage any woman to read these valuable resources, along with the additional resources provided by their clinician. First, before the procedure, women must be able to speak to their doctor or nurse about what to expect and about pain relief options, including local or general anaesthetic, but, as we know and as the Cumberlege report has recently shown us, women’s voices are very often not listened to.