Katharine Tylko

Hysteroscopy patients have a right to ask for general anaesthetic upfront but under-resourced NHS clinics are coercing women into attempting 'Trial by Outpatient Hysteroscopy' first. One patient describes this as 'torture by nice people'.

https://www.sbk-healthcare.co.uk/home/title/2428/nhsconference/updating-and-adapting-outpatient-hysteroscopy-(oph)/?fbclid=IwAR1mgXi4QXIe8OjJOHiYRBouFpWx6QCdcHPniVTMBnx7GRKAQYkHa5-X5XY

The Department of Health and the British Society for Gynaecological Endoscopy (BSGE) are heavily promoting outpatient hysteroscopy. The Dept of Health's long-standing Best Practice Tariff incentivising OP hysteroscopy has meant hospitals have stopped investing in theatre places for hysteroscopy. Women who ask for GA hysteroscopy go onto a long waiting list. Despite the Campaign Against Painful Hysteroscopy's work to give patients their 'Montgomery' legal right to informed choice, and also to improve patient selection and pain-control in outpatients, the Dept of Health continues to hype OPH. The attached file is of a workshop to encourage gynaecologists to 'kickstart' outpatient hysteroscopy services on the basis of 'patient feedback'. Hmmm. The Dept of Health and many of the BSGE's hysteroscopists are ignoring or downplaying the excruciatingly painful OPH experienced by far too many patients throughout the NHS.

The staff at the independent Care Opinion site completely independently of the Campaign Against Painful Hysteroscopy did their own pictorial analysis of the hysteroscopy stories they received. They concluded the main problem was: PAIN.

To read some more horror stories from the Care Opinion website demonstrating the lack of safeguards in NHS outpatient hysteroscopy go to: https://www.hysteroscopyaction.org.uk/wp-content/uploads/2018/10/sept-2018.pdf There's also an essay on 'How the NHS gets away with torturing 1 in 4 women'.

My GP kept delaying referring her patient with womb cancer symptoms for hysteroscopy. When I finally asked why I wasn't being referred, she explained, "you'd freak out at an NHS gynae clinic". She knew what experience a childless woman with severe dysmenorrhea could expect. She told me a general anaesthetic would cost me over a £1,000. I fought hard over several months and countless medical appointments to be allowed an NHS GA which showed stage 3c womb cancer. Fantastic NHS surgical care & masses of radiotherapy worked. In the local Macmillan gynae cancer support group I help run - over the last 7 years I've yet to meet a woman who had anything other than a 'brutal' outpatient hysteroscopy. Yes - throughout the NHS some women do have excellent experiences but most clinics are staffed by under-skilled or over-confident operators, under pressure to perform hysteroscopy as quickly and cheaply as possible. Yes - there are slighter higher risks when hysteroscopy is performed under GA. So we need the NHS to fund, train and safely resourced and monitored procedural IV sedation with analgesia for hysteroscopy. It exists in Sheffield, Newcastle and a few other hospitals. This would bring the patient experience of endoscopy of the womb in line with endoscopy of the colon, stomach etc. It would give women the option of having a pain-free and relatively stress-free experience. We need CHOICE of pain-control according to a woman's preference and medical need. Not just 'Trial by Outpatient Hysteroscopy' with 'vocal-local' hairdresser chit-chat then tea and biscuit for shock. Thank you Patient Safety Learning Hub for listening to an all-too common story.