Recommendation 9

HM Government Deferred

It is unacceptable that some women have such poor experiences during procedures such as hysteroscopy, IUD (intrauterine device) fitting and cervical screening. Experiences of pain during these sorts of procedures can vary significantly from one woman to another. Some women may find the procedure very painful if they are not provided with the appropriate pain relief and support, while others experience little or no pain. As with all procedures, we expect healthcare professionals to fully explain the procedure in advance, including: expected symptoms side effects risks These conversations should be undertaken using a shared decision-making approach that ensures individuals are supported to make decisions that are right for them. This provides a collaborative process through which a clinician supports a patient to reach a decision about their treatment, bringing together: the clinician’s expertise, such as treatment options, evidence, risks and benefits the patient’s preferences, personal circumstances and values NHS England has published a summary guide on the use of shared decision-making (linked in the government response to ‘Recommendation 8’ in ‘Accessing treatment and support’ above). Procedures should be carried out by trained professionals who: prioritise the patient experience create a supportive environment ensure patients know they can request that the procedure stop at any time Where appropriate, referrals should be made to providers who can offer additional pain relief options. Membership and professional bodies have developed a number of guidelines to support clinicians in the delivery of procedures, and DHSC expects providers and healthcare professionals to have regard to relevant clinical guidelines. For example, RCOG published an updated Green-top Guideline No. 59 on outpatient hysteroscopy in September 2024. The guideline is for health professionals and aims to support the provision of evidence-based, high-quality care, with particular reference to minimising pain and optimising the patient experience. While RCOG guidelines are not mandatory, they are designed to: support high-quality care encourage local implementation tailored to patient needs and institutional capabilities FSRH has published clinical guidance on intrauterine contraception procedures . This highlights the need to provide effective pain relief and address patient anxiety. FSRH guidance: stresses that healthcare professionals should work in partnership with patients to establish the best strategies for reducing anxiety and minimising pain highlights the importance of identifying individuals who may experience more discomfort, allowing for tailored pain relief and support For cervical screening, informed consent is supported through information signposted within the Cervical screening: leaflet for women considering screening invitation. This includes: advice on the relevance of screening in relation to sexual history a clear description and diagram of the screening process (including the use of a speculum) what to do if someone thinks having screening will be difficult for them It supports autonomy, explaining that screening can be stopped on request at any point. NHS information is also available specifically for people who find it hard to attend cervical screening . This: covers ways in which screening may be made more accessible for people with a history of trauma or abuse includes a checklist printout for people to use if they don’t wish to verbally explain their concerns NHS Cervical Screening Programme good practice guidance provides sample takers with information on supporting people who have experienced trauma or sexual abuse. Despite this, we know that some women have very difficult experiences with such procedures. NHS England will hold a roundtable on procedural pain in spring 2025. This event will bring together stakeholders to: discuss issues raised through women’s lived experiences review professional training needs identify system changes required to prioritise the recognition and management of pain The scope of this work will include both: procedural pain (for example, from IUD insertion) pain associated with conditions such as menstrual pain and endometriosis It will incorporate findings from a literature review (academic and grey literature), patient stories, complaints and focus groups to develop actionable recommendations for implementation. The roundtable and subsequent recommendations will help consolidate insights and address gaps in care, ensuring that all women undergoing procedures are treated with respect, compassion and appropriate pain management.