Gynaecological Services: Waiting Lists

I beg to move,

That this House has considered waiting lists for gynaecological services.

It is a pleasure to serve under your chairship, Mr Robertson. I start by thanking the many women who have contacted me about this issue, whether in my role as co-chair of the all-party parliamentary group on endometriosis or as chair of the all-party parliamentary group on surgical mesh. The APPG on women’s health has been in contact, and we have also received testimony through the House services from so many women raising their concerns about gynaecological treatment. I thank the Minister for still being in his place to respond to me at the end of today’s debate—it is appreciated.

The debate will focus on the length of waiting lists for gynaecological treatment, and the amount of time people spend on those lists. It has been prompted by the findings of the Royal College of Obstetricians and Gynaecologists report, “Left for too long: understanding the scale and impact of gynaecology waiting lists”. However, I remind Members that when we talk about statistics, it is easy to forget the real people who lie behind them—those individual lives—who do not exist in isolation. When people’s health is impacted, it impacts their families, their friends, their communities and their work. As we will hear, the length of waiting lists is prolonging the suffering of tens of thousands of women, and that suffering has physical, economic and emotional costs.

Gynaecological waiting lists across the UK have now reached a combined figure of more than 610,000—a 69% increase on pre-pandemic levels. An observer might say, “Well, of course. There’s been covid, there’s been a pandemic—what do you expect?” The total pausing of elective care at the start of the covid pandemic has, of course, had an impact. That observer might add, “Our NHS has been chronically underfunded for the past 12 years. There was a steady increase in waiting lists even before the pandemic, and the 18-week waiting time standard for planned elective care has not been met since 2016, so why are you just having a debate on gynaecological treatments? Why not have a debate on waiting lists in general?”

The answer is that RCOG’s analysis shows that gynaecology waiting lists in England have seen the largest percentage growth of all elective specialities, and the largest percentage increase in patients waiting over 18 weeks from referral to treatment. The number of women waiting over a year for care has increased from just 66 in February 2020 to nearly 29,000 two years later, at the end of April 2022—the highest number ever recorded. Concerted efforts across the NHS to focus on longer waiters—that is, patients who have been waiting over a year—have resulted in a drop across all specialities combined from the peak in 2021. However, for gynaecology procedures, the numbers are going in the opposite direction: while we are seeing a reduction in waiting over a year for other treatments, we are not seeing the same for gynaecological treatment.

In addition, we have the prospect of even more cases in the pipeline. Analysis by Lane Clark and Peacock’s health analytics team on behalf of RCOG shows that between March 2020 and November 2021, more than 400,000 women who were expected to join the waiting list based on referrals in previous years did not do so. Therefore, those people are missing from the data I have just mentioned. The number of missing referrals tended to be higher in areas where the waiting lists were already larger. Perhaps that means that women in areas with longer waiting lists are, coincidentally, not going to their GPs, or perhaps it is because they are not able to see their GPs, or their GPs are not responding to those longer waiting lists. We are not quite sure what is going on, but what we do know is that lots of women are not getting the treatment they need.

As I mentioned at the beginning of my speech, I am co-chair of the all-party parliamentary group on endometriosis and chair of the APPG on surgical mesh. Both come under the heading of gynaecological conditions, and both are being impacted by increased waiting times. Endometriosis is the second most common gynaecological condition. It impacts around 1.5 million women—one in 10—in the UK and can affect all women and girls of childbearing age. It is caused by cells that usually form part of the womb lining growing elsewhere in the body, but they still react to the monthly cycle of hormones that regulate a woman’s period. That can create extreme pain and fatigue, because the cells are growing in completely the wrong place.

Part of the APPG’s role is to raise awareness of the condition and get people to talk about it. One in 10 women have it, but I am not sure that one in 10 people in the country know anything about the condition or the fact that it even exists. Many of the sufferers are facing increased waiting time for the procedures I am highlighting today. Even pre-pandemic, people were waiting on average seven and a half years for a diagnosis.

I want to quickly mention surgical mesh, because tomorrow is the second anniversary of the report “First Do No Harm”, which was commissioned by the then Secretary of State for Health and Social Care, the right hon. Member for South West Surrey (Jeremy Hunt), and undertaken by Baroness Cumberlege, to look at the condition. Surgical mesh was used in the surgical repair of pelvic organ prolapse and to manage stress urinary incontinence. It was promised to be simple and quick, but for some it has resulted in severe complications, including chronic pain, infections, reduced mobility, sexual difficulties and autoimmune issues. Lives have been shattered and the issue of mesh injury, along with the scandal surrounding hormone pregnancy, resulted in the “First Do No Harm” report.

Women have been left disabled by the mesh treatments. One of the key recommendations of the report, which, to the shame of this Government, are still not fully implemented two years on, was the establishment of specialist mesh treatment centres. Some of these have opened, but they are beset with problems over access, waiting times and cancellations. Through my involvement with these centres, I have heard at first hand the testimony of so many women whose lives have been blighted by what are currently referred to in the NHS as “benign” conditions. Yet, as we have heard, these conditions can be so painful and debilitating that they impact on every aspect of family, social and work life.

One lady, Kelly, said:

“The impact the long waiting lists have on my life is horrendous. I have endometriosis and adenomyosis and the daily pain these conditions cause me is terrible. Some days simple tasks like walking are unbearable. I have been on the waiting list for surgery for my endometriosis since 2019, and the length of time I am currently having to wait and the symptoms I am having to deal with daily are massively affecting every aspect of my life and having a profound effect on my mental health. I have been told that despite going on the waiting list for surgery in 2019 I will likely be waiting 4 years to get my surgery. Every day is a struggle.”

These conditions are not benign and cannot wait.

“Benign” suggests that there is no harm in delaying treatment, but that is emphatically not the case. For both endometriosis and mesh injury, longer waiting times can have a significant impact on progression. As time passes, options narrow, opportunities are lost and surgery becomes more lengthy and complex. Mental health deteriorates and depression, anxiety and suicidal thoughts become more common.

This is borne out by the most recent data from RCOG. Nearly three quarters of the members surveyed felt that they were seeing women with more complex care and treatment needs as a result of waiting longer for care, resulting in worsening and often extremely debilitating symptoms. Four fifths of the women surveyed reported that their mental health had been negatively impacted while waiting for care. So why are the waiting lists for gynaecological treatments growing? Is it the lack of priority they have been given simply because they are considered benign and not a threat to life? Or is it because gynaecological treatment is the only elective treatment unique to women?

There is undeniably a problem with the health service’s attitudes, in some places, to women’s health, where it involves reported symptoms and the voice of the patients themselves. I stress that I continue to give my wholehearted to the medical profession and everything it does, but there seems to be a concern particularly around the treatment of women’s health conditions.

“First Do No Harm” contains a section headed, “‘No-one is listening’—The patient voice dismissed”. In this case, “patient” is synonymous with “woman”. Although the following passage from the report refers to “mesh complications”, it applies equally to any other gynaecological condition. The report, published two years ago tomorrow, says:

“Women, in reporting to us their extensive mesh complications, have spoken of excruciating chronic pain feeling like razors inside their body, damage to organs, the loss of mobility and sex life and depression and suicidal thoughts. Some clinicians’ reactions ranged from ‘it’s all in your head’ to ‘these are women’s issues’ or ‘it’s that time of life’ wherein anything and everything women suffer is perceived as a natural precursor to, part of, or a post-symptomatic phase of, the menopause. For the women concerned this was tantamount to a complete denial of their concerns and being written off by a system that was supposed to care.”

Amatullah said:

“My GP actually laughed at me when I initially expressed concern that my condition was worsening despite my family history. I had to be hospitalised with suspected appendicitis before I was taken seriously enough to have more testing to see if my fibroids had grown. They had doubled in one year.”

Joanna said:

“As a newly qualified junior doctor, who hopes to specialise in gynaecology, I can’t stress enough how important this debate is. For too long, women’s pain has been ignored or dismissed. The topic is considered taboo despite it being something that a significant percentage of women experience.”

Do such attitudes reflect the prioritisation of gynaecological procedures? The facts certainly point to its neglect in comparison with other procedures. In the RCOG report, both the women and the RCOG members surveyed describe the way in which gynaecological conditions were perceived and prioritised as one of the biggest barriers to reducing the length of the wait time.

I want to quickly mention the data that I was sent from the APPG on women’s health. This is from its “Informed Choice” report of 2017. The APPG’s survey of 2,600 women showed that 42% were not treated with dignity and respect; 62% were not satisfied with the information that they received about treatment options; and nearly 50% of women with fibroids and endometriosis were not told about the short or long-term complications from their treatment. That information is from 2017, so we cannot put all that down to the pandemic. I hate to say this, but there is a problem with people’s attitudes to women’s health when it involves reported symptoms and the voice of patients.

When the Government finally publish their women’s health strategy—something the Labour party has been calling for since 2019—they should include an investigation into possible gender bias in the prioritisation of gynaecological services, and an end to the use of the term “benign gynaecology” to describe gynaecological conditions such as endometriosis, fibroids and polycystic ovary syndrome. There needs to be a shift in the way gynaecology is prioritised as a speciality across the health service. I understand that the RCOG is keen to engage on that with the NHS in all four regions.

I have given a few examples, but there are so many more. I really was inundated with testimonies from women ahead of this debate. There were so many cases and examples of the terrible effects that a prolonged wait for treatment can have. The prioritisation of care as part of NHS recovery must look beyond clinical need and consider the wider impacts on patients waiting for care. There must be a significant re-think in the development of a prioritisation framework for recovery that considers the impact of ongoing symptoms on an individual’s physical and mental health, their quality of life, their fertility, and their ability to participate in work, family and social life.

The RCOG has offered to work with stakeholders across all surgical specialties and the NHS to look at what the framework could look like in practice. We have an unequal growth of gynaecological waiting lists compared with other specialities, and that must be addressed as a matter of urgency. We have seen that there is in all likelihood a huge reservoir of unreferred cases, which will only worsen an already unacceptable situation. The RCOG is seeking a national ringfenced budget for recovery and long-term sustainability of elective gynaecology, with national funding to support local solutions. We obviously need to focus that funding on areas with the longest waiting lists and where disparities are greatest.

The NHS in each nation should commit to tracking and publishing progress on reducing disparities in elective waiting lists. The Government must use the women’s health strategy to commit to mandating co-commissioning of sexual and reproductive healthcare, removing the barriers for services outside of hospitals to support women in their communities.

Finally, Conservative Governments have presided over more than a decade of underfunding in our NHS, and that must be addressed. RCOG members were very clear that staffing is the biggest barrier to reducing waiting lists in outpatient settings and in theatre, and to increasing the number of beds. In March, unfilled posts across health services in England rose to more than 110,000, including nearly 40,000 nurses and over 8,000 doctors. Yet nearly 800 medical undergraduates who applied to start training as junior doctors at the start of August this year have been told that there are no places for them—that is the highest number ever. And despite an increase in applications for nursing degrees this year, the number of applicants remains below that of 2016, which incidentally was the last time that a bursary was available to financially support student nurses before it was scrapped.

The answers to gynaecological waiting lists lie in front of us. However, without the necessary action from Government and the funding to increase staff numbers, there will be no sustainable solution to reducing them. Instead, the Government are content to let the NHS limp along, understaffed, overstretched and with record waiting lists and the personal suffering and wider damage to society that they bring.

It is an absolute pleasure to serve under your chairship, Mr Robertson. I will not detain hon. Members long with my speech, but I do want to say how grateful I am to my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and what a privilege it is to follow her excellent contribution. So much of what she said about waiting causing harm and the attitude of health services to women I will echo in my speech, because today I want to talk about waiting lists for women who need hysteroscopy.

The thing that I want to emphasise today is that many of those women are having to make a terrible choice—a Hobson’s choice. Either they have that really important procedure—it will determine their health prospects—as soon as they need it and without an anaesthetic, or they can wait and wait and wait until an anaesthetist and a theatre are available. I have now spoken about the issue of painful hysteroscopy in the House nine times, trying desperately to get Ministers to secure a change in the behaviour of the NHS towards women. And every time I speak, more and more women contact me afterwards to tell me about the brutalisation that they have experienced. The stories never stop. Although I am assured by Ministers that action is being taken, will be taken and so on, the stories just go on.

I will share just two stories today. Had I known that only my hon. Friend the Member for Kingston upon Hull West and Hessle and I would be here on the Back Benches, I would have brought more—because I love to watch a Minister squirm—but I have only two stories with me today.

I want to talk about Emily, who is in her 70s. She gave birth twice—once without pain relief, after a very long labour. Therefore, we are talking about a woman who can cope with a certain level of pain without difficulty. When Emily, who is, I repeat, in her 70s, had her hysteroscopy, she was not offered any pain relief, and her procedure was excruciatingly painful. The word that she uses and that many, many women who have written to me use also is “brutal”. The pain was so bad that Emily, in her 70s, passed out. It is appalling, and every single person sitting in this room and watching from home knows that. Emily should have been given the decent, fair choice of having the procedure with an effective anaesthetic and without having to wait months.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and for her continued advocacy of this issue and many issues affecting health inequality, which predominantly affects women. I praise the contribution of my hon. Friend the Member for West Ham (Ms Brown), who set out some harrowing stories of women undergoing hysteroscopy, such as Emily and Francesca, who are ignored and brushed aside. We know that there are thousands more Emilys and Francescas.

That is why the debate is so vital—not just because of the need for meaningful progress on the long-promised women’s health strategy, but because fundamentally we are discussing issues that affect more than 50% of the population. Too often women’s health is pigeon-holed as niche and as a subsection of healthcare. The idea that gynaecological conditions are manageable for long periods of time, and can be deprioritised as a result, is just not acceptable.

Let me set out what that deprioritisation means. It means endometriosis surgery being delayed five times, resulting in irreversible fertility loss, and severe chronic pain. That perception must change, and women must be given the access to healthcare that they desperately need. Any other area of public policy that affected more than half of the population would not be treated in that way, and quite frankly, women have had enough.

We know that timely access to healthcare matters to women, and to young women in particular—the Government’s consultation on women’s health strategy tells us so. Gynaecological conditions were the No.1 topic chosen by women under 30, yet they are being consistently let down and made to wait day after day, year after year. Waiting lists are spiralling in all parts of the NHS, with records being broken consistently, but in gynaecology those spiralling lists are having a disproportionate impact. As we have heard, the Royal College of Obstetricians and Gynaecologists has found that gynaecological waiting lists across the UK have now reached 610,000—an increase of more than 106% since 2008. That backlog is made worse by significant geographic disparities in care.

I would just say that if I am still in post on Sunday, I will be the third-longest serving Minister of State for Health since 1970, but only time will tell. I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate about waiting lists for gynaecological services. I know this is a very important subject for her, and I would like to take a moment to highlight her well-known focus in this House on women’s health matters and the work she has done in that space, which reflects the importance many of our constituents attach to these issues.

As has been alluded to, the hon. Member for Kingston upon Hull West and Hessle has done important work on the suspension of the use of vaginal surgical mesh. She has also worked to promote menstrual wellbeing and worked with Endometriosis UK. I congratulate her on that. It is always a pleasure to answer a debate of hers or to respond to her in the Chamber. It is also a great pleasure to be able to respond to the hon. Member for West Ham (Ms Brown), who as ever gave a typically powerful and forthright speech. She highlighted some harrowing examples—as the shadow Minister put it—that illustrate the broader issues around hysteroscopy and particularly the challenges around the NHS listening and acknowledging patients’ genuine concerns and requests. I will return to that in a moment. Normally at this point I would offer to meet with the hon. Member for West Ham to discuss this, but I will instead offer that the relevant Minister meet with her to discuss this matter further and the specific points she raised with her typical forthrightness and expertise.

The covid-19 pandemic has left a large backlog of people needing care. The latest figures show that 6.53 million people are waiting for NHS care, with 1.55 million of these waiting for diagnostic tests. As part of this, the waiting list for gynaecological services has over 28,800 people waiting longer than a year for care. We are working hard to reduce the number of people waiting for these vital services as swiftly as we can. It is promising that activity levels have reached 95% of their pre-pandemic levels in this area, but that is still 5% short of what normal activity would have been pre-pandemic. We recognise that more needs to be done in this space.

When that is published, will it include the point I made about looking at whether there is a gender bias in the prioritisation of health treatment? That was something that the RCOG was really keen to emphasise. Everyone understands that covid meant waiting lists for everything. One of my key points was whether there is a gender bias? Is that partly why gynaecological treatment seems to be delayed more than others?

I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.

I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.

I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.

In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.

More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.

What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?

The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.

I thank the Minister for again giving way. When we see the women’s health strategy, will it respond to all of the recommendations from the Cumberlege review? We had a bit of an interim response to the review, but I am sure the Minister will be aware that there is still a cross-party campaign to ensure that all of those recommendations are fulfilled. If he ever does happen to find himself on the Back Benches, he is more than welcome to join any of my APPGs, and any of those campaigns, from a different side. I would be keen to know whether he is aware of any plans to fully address the report and fulfil those recommendations.

I am grateful to the hon. Lady. She highlights an issue that I know has exercised Members on both sides of the House. Although progress has been made, I know that a campaign on other elements continues. This makes me sound as I used to occasionally, doing the morning media round and talking to Kay Burley or similar, but I do not want to prejudge what might be said in due course—that was sometimes a wise thing to say when discussing infection rates, restrictions or similar. I do not want to prejudge or predetermine what will be in that strategy, but I genuinely hope and believe that the hon. Lady will be pleased when she sees it. I would not for a moment expect her not to challenge it and seek to improve it, because I have worked and interacted with her before, and that is what Members do in this House. However, I hope that she will see progress in there.

We know that diagnostics are a key area in many gynaecological pathways. As such, we are establishing up to 160 community diagnostic centres across the country by 2025. There are currently 90 such centres operating across the country, including supporting spoke sites, and they have delivered 1 million tests and scans since July 2021. The expansion of the centres will mean that the NHS will have just shy of 38% more MRI capacity, 45% more CT capacity, 26.8% ultrasound capacity improvements, and an increase of around 19% in endoscopy capacity by March 2025, compared to pre-pandemic levels. That will allow more patients to be seen more quickly, meaning they can be diagnosed sooner and then start any treatment they need.

I will turn briefly to general practitioners, who are often key in the treatment of gynaecological conditions. As we all know, general practices are still very busy and are caring for patients in the community who are on waiting lists for secondary care. I pay tribute to the work of general practitioners and their teams throughout the pandemic. We know that some patients have struggled to get through to their GP practice on the telephone, which is why the NHS offered practices an interim telephony solution that enabled them to use Microsoft Teams to free up lines for incoming calls.

I thank everyone who has taken part in the debate. In different circumstances this would have been a very full debate. I look forward to seeing the women’s health strategy as soon as possible. I feel I have been unable to give coverage to the number of women who have contacted me, but I say to them that I have read each and every one of their messages. The testimony that they give is incredibly moving, and clearly something needs to change.

Issues around women’s health appear to be disproport-ionately impacted, and that is not right. I am sure we will all raise this subject again and, in all sincerity, the Minister is always welcome to campaign with me on this issue from the Back Benches.

That this House has considered waiting lists for gynaecological services.