Outpatient hysteroscopy/biopsy - RCOG Patient Information Leaflet

Katharine Tylko-Hill made this Freedom of Information request to Lancashire Teaching Hospitals NHS Foundation Trust

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Katharine Tylko-Hill

Dear Lancashire Teaching Hospitals NHS Foundation Trust,

Outpatient Hysteroscopy/Biopsy – RCOG Patient Information Leaflet

Further to the information your Trust supplied stating that you are not using the RCOG Outpatient Hysteroscopy patient leaflet,

1. Please has your Lead hysteroscopist read the Montgomery v. NHS Lanarkshire ruling on informed consent? [Y/N]

https://www.supremecourt.uk/cases/docs/u...
“The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in proposed treatment, and of reasonable alternatives. A risk is “material” if a reasonable person in the patient’s position would be likely to attach significance to it, or if the doctor is or should reasonably be aware that their patient would be likely to attach significance to it.”

2. Please has your Lead Hysteroscopist read the RCOG guidance on consent https://www.rcog.org.uk/globalassets/doc...

“Women should not be given important information or asked to make decisions at the same time as undergoing gynaecological examinations.7
In the modern NHS, efficiencies such as placing patients directly onto waiting lists and admitting patients to hospital on the day of operation require careful attention to the organisation of consent. These initiatives have the potential to shorten or even eliminate the ‘cooling-off’ period during which a woman is able to reflect on her condition and the proposed treatment options. If written consent in the presence of the operating practitioner is to be obtained immediately before the operation, it is vital to ensure that she has been offered the opportunity to further discuss any intervention in a clinic visit or a visit to a preoperative assessment unit. If not, and women are being presented with information anew for the first time or are doubtful, deferral must be retained as an option in the best interests of patient care even if it means that their procedure is postponed. Such women should also be sent detailed information packs with a copy of the appropriate consent form.” [Y/N]

3. Please has your Lead Hysteroscopist read the RCOG Outpatient Hysteroscopy patient information leaflet https://www.rcog.org.uk/en/patients/pati... which warns of the material risk of severe pain; identifies cohorts of patients at high risk of severe pain; and advises women that they may choose to have a general anaesthetic? [Y/N]

“Are there alternatives to having outpatient hysteroscopy? There may be other things to consider when deciding whether OPH is the right choice for you, such as:• if you faint during your periods because of pain• if you have experienced severe pain during a previous vaginal examination• if you have experienced difficult or painful cervical smears• if you have had any previous traumatic experience that might make the procedure difficult for you• if you do not wish to have this examination when awake. You may choose to have your hysteroscopy with either a general or spinal anaesthetic. This will be done in an operating theatre, usually as a daycase procedure. You can discuss this option with your healthcare professional. The risks and complications are lower when hysteroscopy is done as an outpatient procedure rather than under anaesthesia.”

4. Does your Trust now intend to start using the RCOG Outpatient Hysteroscopy patient information leaflet, and if so, when? [Y/N]

5. If the answer to Question 4. is NO, please why is this? Is it because
a) You run a See & Treat clinic and the patient may not need a hysteroscopy [Y/N]

b) You don’t want to mention severe pain and make patients anxious? [Y/N]
c) You don’t want patients to choose GA because it will affect your hysteroscopy Best Practice Tariff? [Y/N]
d) You don’t want to put patients through the higher risk of perforation under GA due to use of wider hysteroscopes? [Y/N]
e) You don’t want to give patients the choice of GA because there is a long waiting-list which will delay cancer diagnosis [Y/N]
f) You don’t have the budget to print out a new, longer leaflet? [Y/N]
Any other reasons ... please specify.

With many thanks for your help in improving the early diagnosis of womb cancer.

Yours faithfully,

Katharine Tylko-Hill

Freedom of Information (LTHTR), Lancashire Teaching Hospitals NHS Foundation Trust

Dear Katharine,

Please can I check that you received our response to your previous
request?  It stated that we are updating our own leaflet to incorporate
the RCOG guidance; please can I check that this new request is necessary?

Regards,

Freedom of Information Officer
Lancashire Teaching Hospitals NHS Foundation Trust
c/o The Medical Director’s Office
Royal Preston Hospital
Sharoe Green Lane
Fulwood, Preston, PR2 9HT
Email : [email address]
www.lancsteachinghospitals.nhs.uk
@LancsHospitals
Excellent care with compassion
       
Ranked #1 NHS Clinical Digital Maturity Index Acute rankings June 2018
  

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Katharine Tylko-Hill

Dear Freedom of Information (LTHTR),

Yes, please the request is necessary.

The RCOG patient leaflet is 7 pages long, extremely comprehensive, and includes information vital to prevent patients undergoing an excrutiatingly painful procedure.

The RCOG leaflet specifically states the risk of SEVERE pain during OP hysteroscopy and specifically lists cohorts of patients at highest risk of severe pain. The RCOG leaflet specifically offers patients the option upfront of general anaesthetic for hysteroscopy should this be their preference.

The RCOG leaflet is compliant with the Montgomery v. NHS Lanarkshire ruling on informed choice.

Please would you therefore send me a link to the new leaflet which your Trust is preparing so that I may check how the information it give patients compares with that of the RCOG leaflet.

With many thanks,

Yours sincerely,

Katharine Tylko-Hill

Freedom of Information (LTHTR), Lancashire Teaching Hospitals NHS Foundation Trust

3 Attachments

Dear Katharine,

Lancashire Teaching Hospitals NHS Foundation Trust has processed your
request for information submitted under the Freedom of Information Act. I
can confirm that the trust does hold the information requested, please see
our response below/attached.

FOI Request 6787

1. Please has your Lead hysteroscopist read the Montgomery v. NHS
Lanarkshire ruling on informed consent? [Y/N]

[1]https://www.supremecourt.uk/cases/docs/u...

“The doctor is under a duty to take reasonable care to ensure that the
patient is aware of any material risks involved in proposed treatment, and
of reasonable alternatives. A risk is “material” if a reasonable person in
the patient’s position would be likely to attach significance to it, or if
the doctor is or should reasonably be aware that their patient would be
likely to attach significance to it.”

Trust response: Yes

2. Please has your Lead Hysteroscopist read the RCOG guidance on consent
[2]https://www.rcog.org.uk/globalassets/doc...

“Women should not be given important information or asked to make
decisions at the same time as undergoing gynaecological examinations.7 In
the modern NHS, efficiencies such as placing patients directly onto
waiting lists and admitting patients to hospital on the day of operation
require careful attention to the organisation of consent. These
initiatives have the potential to shorten or even eliminate the
‘cooling-off’ period during which a woman is able to reflect on her
condition and the proposed treatment options. If written consent in the
presence of the operating practitioner is to be obtained immediately
before the operation, it is vital to ensure that she has been offered the
opportunity to further discuss any intervention in a clinic visit or a
visit to a preoperative assessment unit. If not, and women are being
presented with information anew for the first time or are doubtful,
deferral must be retained as an option in the best interests of patient
care even if it means that their procedure is postponed. Such women should
also be sent detailed information packs with a copy of the appropriate
consent form.” [Y/N]

Trust response: Yes

3. Please has your Lead Hysteroscopist read the RCOG Outpatient
Hysteroscopy patient information leaflet
[3]https://www.rcog.org.uk/en/patients/pati... which warns of the material
risk of severe pain; identifies cohorts of patients at high risk of severe
pain; and advises women that they may choose to have a general
anaesthetic? [Y/N]

Trust response: Yes

“Are there alternatives to having outpatient hysteroscopy? There may be
other things to consider when deciding whether OPH is the right choice for
you, such as:• if you faint during your periods because of pain• if you
have experienced severe pain during a previous vaginal examination• if you
have experienced difficult or painful cervical smears• if you have had any
previous traumatic experience that might make the procedure difficult for
you• if you do not wish to have this examination when awake. You may
choose to have your hysteroscopy with either a general or spinal
anaesthetic. This will be done in an operating theatre, usually as a
daycase procedure. You can discuss this option with your healthcare
professional. The risks and complications are lower when hysteroscopy is
done as an outpatient procedure rather than under anaesthesia.”

4. Does your Trust now intend to start using the RCOG Outpatient
Hysteroscopy patient information leaflet, and if so, when? [Y/N]

Trust response: A decision is currently being discussed, the trust
currently hold no recorded information as to dates.

5. If the answer to Question 4. is NO, please why is this? Is it because
a) You run a See & Treat clinic and the patient may not need a
hysteroscopy [Y/N]

b) You don’t want to mention severe pain and make patients anxious? [Y/N]
c) You don’t want patients to choose GA because it will affect your
hysteroscopy Best Practice Tariff? [Y/N]
d) You don’t want to put patients through the higher risk of perforation
under GA due to use of wider hysteroscopes? [Y/N]
e) You don’t want to give patients the choice of GA because there is a
long waiting-list which will delay cancer diagnosis [Y/N]
f) You don’t have the budget to print out a new, longer leaflet? [Y/N]

Any other reasons ... please specify.

Trust response: N/A

6. Please would you send me a link to the new leaflet which your Trust is
preparing so that I may check how the information it give patients
compares with that of the RCOG leaflet.

Trust response: Please see attached.

Regards,

Freedom of Information Officer
Lancashire Teaching Hospitals NHS Foundation Trust
c/o The Medical Director’s Office
Royal Preston Hospital
Sharoe Green Lane
Fulwood, Preston, PR2 9HT
Email : [email address]
www.lancsteachinghospitals.nhs.uk
@LancsHospitals
Excellent care with compassion
       
Ranked #1 NHS Clinical Digital Maturity Index Acute rankings June 2018
  

show quoted sections