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Hi Sandra, this is the first year you are running the Black Maternal Health Conference UK. What made you set up the event? In the last few years, the inequalities affecting Black women’s maternal health have become more widely recognised. As CEO of the Motherhood Group, I’m often asked to present at conferences; to share my insights, lived experience or raise awareness of the disparities in outcomes. I usually have around 45 minutes, sometimes less, to draw on all of the issues we need to be talking about in this space. It’s never enough. It doesn’t do it justice. The Black Maternal Health event in March is going to give us a chance to really dig deeper into these issues. To not have to be explaining such important topics ‘in a nutshell’. Our full and interactive agenda will provide people with much more time to engage with the subject matter and to connect with one another so we can work together for better outcomes. What is the aim of the day? By combining our expert speaker line up with shared experiences from mothers, and creating a safe space for everyone to connect, the day will present us with an incredible opportunity. This is how trust will be rebuilt and progress made. The aim is to really bridge that gap between the Black maternal community and service providers, through learning workshops, panel sessions and by listening to the experts - including those with lived experience. Who can attend? We are welcoming anyone to attend the day and we’ve already had a range of people interested; from Black mothers to charities, researchers and clinical staff. It will be great to bring together different voices and perspectives. Although many people coming will already be interested in this work, you don’t have to know anything about Black maternal health beforehand. I’d personally love to see more healthcare workers and managers signing up to the day. I know so many are keen to improve outcomes for Black women and mothers; to listen, learn and understand what they can do to make a difference. This is the perfect opportunity to do just that. It will be a safe space to really connect and work with others to delve deeper into potential solutions or practical steps. Who is speaking on the day? We have many amazing speakers joining us, please take a look at the full line up on our website. It will give you an idea of how rich the content will be. Contributors include midwife, Marley Hall, presenting on How defensiveness amongst health professionals may be harming outcomes and experiences, and Dr Karen Joash, Consultant in Obstetrics and Gynaecology, leading a session on Moving from maternal mortality and morbidity disparities, to equity for Black mothers. We’ll also be looking at: mental health stigma communication systemic racism faith how to engage Black mothers in research. Can people attend virtually as well as in person? Yes! We are offering the event virtually too and you will be able to interact from a distance in various ways. If you have the opportunity though, we’d love to welcome you in person as I think it provides a great opportunity to network and connect face-to-face. Any final thoughts to share? It is so important that Black women receive maternal health care that is respectful, culturally competent, safe and of the highest quality. If you want to engage in the issues surrounding poorer health outcomes for Black mothers, it takes time, resource and effort. That’s why we’ve tried to design a day that provides enormous value and welcomes you into a truly collaborative space where we can listen, learn and take action together. So don’t be shy, join us on 20 March. Register here Event hashtag - #BMHCUK Stay connected with the Motherhood Group Twitter: @MotherhoodGroup Facebook: The Motherhood Group YouTube: The Motherhood Group Instagram: @TheMotherhoodGroup Website: www.themotherhoodgroup.com References [1] MBRRACE-UK Saving Lives Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20 [2] Watson H, Harrop D, Walton E et al. (2019) A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe. PLOS ONE 14(1) [3] Kozhimannil KB, Trinacty CM, Busch AB et al. Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatr Serv. 2011 Jun;62(6):619-25

Over the past few years, Patient Safety Learning has heard from many patients about significant safety concerns relating to hysteroscopy procedures in the NHS.[1] From the countless women who have shared individual experiences on the hub to the conversations we have had with the patient group the Campaign Against Painful Hysteroscopy, it is clear that this is a topic needing further exploration and advocacy from a patient safety perspective. I therefore welcomed a recent opportunity to engage with healthcare professionals involved in hysteroscopy procedures and share these concerns when I was invited to attend the Association of Anaesthetists Winter Scientific Meeting 2023 last month. This is the Association’s flagship conference, attended by healthcare professionals from across the UK, and I was invited to contribute to a panel session. This was focused on differing approaches to sedation for hysteroscopy procedures in both operating theatres and outpatient settings. Healthcare professional perspective from Leeds Hysteroscopy is a procedure used as a diagnostic tool to identify the cause of common problems such as abnormal bleeding, unexplained pain or unusually heavy periods in women. It involves a long, thin tube being passed through the vagina and cervix, into the womb, often with little or no anaesthesia. The panel session started with a presentation about hysteroscopies from Dr John Dalton, Dr Tracy Jackson and Maria Chalmers, Specialist Nurse Hysteroscopist. Maria spoke about the approach to hysteroscopy at the Leeds Centre for Women’s Health, emphasising the importance of: appropriate patient consent for the procedure discussing the likelihood of pain in advance of obtaining consent the patient’s right to withdraw consent or stop the procedure at any time. They described how patients, if they wanted to, were invited to review the procedure on a screen, and reported that there had been positive feedback from patients who have undergone procedures with this option. They also spoke about the value of these procedures taking place in outpatient settings where possible, creating a quicker diagnostic assessment. In their presentation, they reflected on the importance of collecting data about patient outcomes and pointed to broadly positive satisfaction scores with their service. Reflections on consent It was positive to hear a strong emphasis on the importance of patient consent, both before and during a procedure. It is an area of concern that has been consistently raised with us by patients who have undergone hysteroscopy. Through our work, we know that a significant number of women are not given sufficient information beforehand about the nature of the procedure or the potential for high levels of pain. Many have told us they were not asked about their medical history or offered different options for pain relief. These patients often reflect that the consent they gave was therefore not informed. When a patient experiences unexpected levels of pain, they can understandably feel very unsafe. This can lead to lasting trauma and a fear of accessing further important procedures or screenings. It’s therefore essential to make sure women undergoing this procedure feel they have been given all the information available. Panel discussion I introduced the concerns being expressed by many women and this generated an open discussion with colleagues from Leeds and an engaged audience of anaesthetists, many of whom were unaware of the issues that patients are raising about outpatient hysteroscopy. In the panel discussion I spoke about the experiences that have been shared with us at Patient Safety Learning. Some women have described how the lack of forewarning about this procedure, coupled with the trauma of the experience itself, left them feeling that both their body and their trust had been violated. Many women have also described receiving little or no pain relief and not being given the information they needed to make an informed choice about their own care and their own bodies. More than 50,000 people have viewed our community discussion on the hub about hysteroscopy experiences, with many having shared awful experiences exhibiting bullying, lack of compassion, lack of information and horrendous pain. Recent research, published in the British Journal of Anaesthesia, shows that a significant number (17.6%) of women rate their pain during hysteroscopy as greater than 7/10, and only 7.8% report no pain at all.[2] We know that outpatient hysteroscopy is a valuable procedure when done right, with full information, appropriate pain relief options and informed consent. However, as we have heard all too often from patients, in many cases this is not what they are experiencing.[3] Similar concerns were raised this week in a debate in the House of Commons. When discussing the implementation of good practice in these procedures, Government Minister Maria Caulfield note that such guidance was only as effective as its implementation: “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.”[4] Patients and campaigners are not unsupportive of hysteroscopy as a procedure. However, I shared our view, and that of many, that patients should not be expected to tolerate extreme pain or inconsistency of service. I emphasised a need for: increased efforts to ensure that good practice is shared widely and consistently applied. more research to better inform risk assessments about which women are most likely to affected by severe pain. ensuring that all those healthcare professionals involved in these procedures understand the importance of listening to and responding patients, giving women a range of pain relief options and providing the option to stop the procedure. It was useful to discuss with Maria and other clinical colleagues the value of hysteroscopy and the efforts that some centres are making to ensure that patients’ needs are met, and their voices heeded. It was helpful also to see in person the responses of anaesthetists in the room. There was, in some cases, clear concern about the negative experiences that have been shared with Patient Safety Learning by patients. Then we had some interesting reflections on the pain scores presented by the staff at Leeds. Many anaesthetists expressed shock that despite the good service being provided there, median pain scores are 5 out of 10. Some anaesthetists commented that patients wouldn’t be let out of recovery rooms by nursing staff with that extent of pain, and some said that they themselves wouldn’t want to undergo such a procedure in an outpatient setting with that median pain rating. The discussion was an important multi-disciplinary conversation of the value of hysteroscopy as a procedure while highlighting the very real concerns that women are experiencing when Royal College of Obstetricians and Gynaecologists guidelines are not being met consistently. The opportunity to engage in discussion with clinicians who are aiming to put patients’ experience at the heart of their service was much appreciated and we’re going to follow up with Maria and John to hear more about their service and the plans they have for continual improvement and for the best experience for women. We applaud the Association of Anaesthetists for highlighting these issues and aim to engage further to increase awareness of hysteroscopy pain and the need for urgent action. We look forward to sharing the recording of the session via the hub as soon as it becomes available. Join the conversation There is much work still needed to raise awareness of the patient safety issues concerning hysteroscopy procedures and to make the changes required to ensure good practice is applied consistently across the country. In the coming weeks, we will be publishing a new policy blog looking at this in greater detail and considering what more needs to be done to improve patient safety. In the meantime, if you have an experience you would like to share with us, please do get in touch. Perhaps you are a healthcare professional with insights to share on this topic? A patient who has had a hysteroscopy? A researcher? We'd love to hear from you if have a different perspective to add. You can join the conversation on the hub or get in touch with us directly by emailing content@pslhub.org. References 1. Campaign Against Painful Hysteroscopy, Open letter to the Department of Health and Social Care, 20 October 2020 2. Richard Harrison, William Kuteesa, Atul Kapila, Mark Little, Wiebke Gandhi, Deepak Ravindran, Carien M. van Reekum and Tim. V Salomons, Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy, 13 September 2020 3. Patient Safety Learning, Guidance for outpatient hysteroscopy: Consultation Response, 16 March 2022 4. House of Commons Debate, NHS hysteroscopy treatment, 31 January 2023

Join us to learn how welfare rights advice services are being integrated with healthcare nationwide to tackle poverty and health inequality. This event will be of interest to people working in Integrated Care Systems and public health policy and practice. Taking action on poverty and health inequality is ever more important for the NHS, as the current cost of living crisis increases hardship among communities. The consequences for health and wellbeing will be felt most keenly among low income and vulnerable patient groups. Health justice partnerships are targeted interventions that support patients with social and economic circumstances that are root causes of health inequality. They are partnerships between health services and organisations specialising in welfare rights. Advice on welfare rights issues is integrated with patient care, helping people resolve problems relating to benefits, debt, housing, employment and immigration, among others. This can support those in the hardest circumstances to maximise their health and wellbeing. This one-day in-person workshop is an opportunity to learn about health justice partnerships and how they are being implemented across the country in a range of NHS settings. We will be joined by speakers who are engaged in service delivery, policy and research, who will provide examples and insights from their work. Speakers will include: Professor Dame Hazel Genn, Director of the Centre for Access to Justice, UCL Cedi Frederick, Chair of the NHS Kent and Medway Integrated Care Board Natalie Davis, Head of Legal Support Policy, Ministry of Justice Catherine McClennan, Director of the Women’s Health and Maternity Programme, Cheshire and Merseyside Health & Care Partnership Paul Sweeting, Insight and Performance Partner, Macmillan Cancer Support Refreshments are provided and there will be opportunities for discussion and networking. Outline of the day (provisional timings) 09.15: Registration and refreshments 10.15: Plenary session 1 - Introducing Health Justice Partnerships 11.45: Plenary session 2 - Health Justice Partnership case studies 13.00: Lunch provided 14.00: Plenary session 3 - Implementing Health Justice Partnerships 15.15: Group discussion session 4 - Where next for you? 16.30: Refreshments and networking Please see our website for further information on Health Justice Partnerships. Register for a place This event is supported by The Legal Education Foundation.

Key findings The gap in Index scores between women in high-income and low-income economies nearly doubled between 2020 and 2021. In 2021, 22 points separated women in high-income economies — whose score remained unchanged at 61 — and women in low-income economies, whose score dropped from 49 to 39. Women’s ability to meet their basic needs — such as affording food — fell, while men’s ability to do so did not change. Women were slightly more likely than men to say there were times in the past year when they did not have enough money to afford needed food (37% of women vs. 33% of men). This gap was wider in 2021 than it was in 2020 — as women lost ground while men largely remained steady. Women in 2021 were more stressed, worried, angry and sad than they were in 2020 — or at any point in the past decade. Stress, worry and anger each increased by three percentage points within the span of a year, while sadness notably rose by six points. More than 4 in 10 women in 2021 said they experienced worry (43%) and stress (41%) during a lot of the day before the survey, nearly one in three experienced sadness (32%), and more than one in four experienced anger (26%) — all at record levels. In nearly 50 countries and territories, less than 10% of women said they had been tested for cancer in the previous year. Worldwide, just 12% of women in 2021 were tested for any type of cancer in the past 12 months, which means more than 2 billion of the world’s women went untested. Belief in the value of going to a healthcare professional declined among women with an elementary education or less. While belief in the value of going to a healthcare professional remained relatively stable among women with four years of education beyond high school or a college degree (92%), it dropped seven points among those with an elementary education or less — from 87% to 80% — leading to a 12-point gap between the two groups. Annual visits to healthcare professionals correspond with two additional years in a woman’s life expectancy. Even after accounting for gross domestic product (GDP) per capita, life expectancy for women who said they had been to a healthcare professional in the past year was 78, compared to 76 for women who said they hadn’t been.

Click on each heading to access the relevant content. 1. Presenting complaint: use of language that disempowers patients In this BMJ article, Caitríona Cox and Zoë Fritz argue that outdated medical language that casts doubt, belittles, or blames patients jeopardises the therapeutic relationship and is overdue for change. 2. NIHR - Health information: are you getting your message across? This resource collection from the National Institute for Health and Care Research includes research on the impact of unclear health messages, how we can help people understand health information and which groups of the population may need extra support. 3. The Obs Pod, by obstetrician Florence Wilcock (Episodes 22 and 23: Language) In episodes 22 and 23 of the Obs Pod podcast, obstetrician Florence Wilcock discusses how the language used in her field can have a detrimental impact on the women and families being cared for. 4. NHS England - Language Matters: language and diabetes This guidance by NHS England sets out practical examples of language that will encourage positive interactions with people living with diabetes and subsequently positive outcomes. 5. Why language matters in social care “Words can invite people in, or keep them out”. Listen to this five minute podcast about why language matters and the impact this has on people who access services, hosted by Linda Doherty from Think Local, Act Personal. 6. "We couldn’t talk to her”: a qualitative exploration of the experiences of UK midwives when navigating women’s care without language Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. This study aims to understand the experiences of midwives using language support services. 7. Lost for words: Healthwatch evidence on how language barriers contribute to health inequalities Based on research conducted by Healthwatch, this report examines the difficulties that patients with little or no English encounter at every stage of their healthcare journey. Have your say Have you ever been affected by the language used in healthcare? Perhaps you've felt excluded or offended by the words used. Or maybe you have an example of how clear and inclusive language made you feel safer as a patient? You might be a member of staff who has made changes to the way they communicate face-to-face or in writing to help improve outcomes and strengthen patient-provider relationships. Please let us know your thoughts by commenting below (register for free here first). Or you can get in touch with us directly to share your insights at content@PSLhub.org