Recommendation 19

HM Government · verbatim extract Deferred

It is unacceptable that some women have such poor experiences during procedures such as hysteroscopy, intrauterine device (IUD) 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 screeni [...truncated...] t, every day of the year. They are located across the country and available for everyone. There is also an NHS page on Help after rape and sexual assault, which provides information for those who require it. NHS England will review current website content and develop information and guidance in the most appropriate and accessible format for those who need it. NHS England has also funded enhanced mental health pathways to improve care for victims and survivors with complex trauma-related mental health needs, so that they can recover, heal and rebuild their lives. We are working with NHS England and the Women’s Health Ambassador on how we take forward the Women's Health Strategy for England (linked in 'Introduction' above) by aligning it to the government's missions and forthcoming 10 Year Health Plan. We will consider the committee’s recommendations on additional topics to be considered as we take this work forward.