The Parliamentary Under-Secretary of State for Health (Anne Milton)
I thank the hon. Member for Luton South (Gavin Shuker) for bringing this important issue to the fore in the House again. It is testament to how important the issue is that, at this late hour, the House is filled with many Members who take an interest in it. People rightly feel very strongly about it, and he has made some very important points. In this debate, whatever our respective positions, I think we all agree that women who face a decision about whether to proceed with their pregnancy need support, advice and, indeed, counselling; often, it is a very difficult decision for women to make.
The hon. Gentleman supported the amendment introduced by my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries), and since that debate officials in the Department of Health have been developing and looking at proposals for a consultation on the counselling options in the independent sector and in the NHS for all women considering abortion.
I am working with Members from both sides of the House to look at how we might proceed with the consultation, and I have been impressed by what the hon. Gentleman referred to as the “maturity” of that group of people, who, despite starting from quite opposite ends of the debate, have come together to find out where we agree and, at the end of the day, to ensure that we put forward a consultation that looks at what is best for women.
The consultation will consider how to develop an offer of counselling that is impartial and supportive and, as part of the process, we will look at who is best placed to offer counselling. It is not about automatically including or excluding any one type of organisation; what matters is that we define clearly the outcomes that we want for women. It is important to focus on the process, but we need to be clear about what we are trying to achieve.
Officials have visited several counselling providers to find out more about the services that are offered in terms of the process, the qualifications that their counsellors hold, and what people should expect on booking a counselling appointment. Some organisations are abortion providers, some are services that refer people to abortion providers, and others do not make direct abortion referrals. Official recently visited a Marie Stopes International clinic and a BPAS clinic, and what they found was quite interesting. During the consultation, I am sure that we will hear from many other people with experience of those services.
The proposals are still being developed, and, on an issue that has sought to divide the House in the past, and on which there are sometimes very strong views, it is important that we go into the consultation with one mind. We are confident that, as a result of the work, counselling arrangements will be improved. That is the purpose of the work, and we want to take into account everyone’s point of view so that we put together for consultation the right document that asks the right questions and includes the right options, and so that we hear and know exactly what is the best way forward.
It is clear that good work, delivered by different providers, is going on in many places, but we need to make sure that all women are offered a consistently good service. The repercussions of that not being the case are very serious. The aim of the consultation will be to propose ways to strengthen existing counselling options for women where they are good, improve the services where they fall short, and set out detailed options to achieve that goal.
Thomas Docherty (Dunfermline and West Fife) (Lab)
I commend my hon. Friend the Member for Luton South (Gavin Shuker) for securing this well-measured debate. The Minister will be aware that the Health and Social Care Bill is going through the House of Lords. Will she guarantee that before the Bill leaves the other place and comes back here, she will bring forward a measured package to make sure that there is a consultation about these issues?
Anne Milton
I thank the hon. Gentleman for his intervention, but there is no need for this to be dealt with in legislation. Before today, I have given my word at this Dispatch Box that we will carry out the consultation and bring forward the best options in finding the best way to make sure that women have an offer of counselling should they wish to take it up. It is important to remember that women who access services sometimes do so from a wide variety of directions—they may self-refer or come from their GP. What matters is that we get the offer in the right place. We need to consider whether the woman should have the one offer or whether the offer needs to be continually open because she might turn it down in the first instance, at the first appointment, but want to take it up, say, a week down the line. It is important that we get the detail right. We do not need to put it into primary legislation; in fact, it would arguably be inappropriate to do so. I repeat that I have said from this Dispatch Box, on more than one occasion, what we will do.
As the hon. Member for Luton South said, there is concern that there is a conflict of interest in that counsellors are paid for procedures and yet also expected to provide entirely impartial advice to women. Although there are no formal quality standards in place for counsellors and no minimum standards for training or qualifications, we have found that the majority of counsellors who work in independent sector abortion providers are registered with the British Association for Counselling and Psychotherapy. Underpinning membership of, and accreditation by, this organisation is a thorough ethical framework that counsellors must abide by. However, sufficient concern has been expressed, so we are looking at everything in the round to make sure that the sector is not only independent but has the confidence of the public that it is independent. It is important to say that independent sector abortion providers and organisations that refer women for an abortion are subject to the Secretary of State’s approval and monitoring by the Care Quality Commission. Marie Stopes International, which is one of the leading abortion providers, has reported that 20% of its clients decided not to go through with the termination following counselling. That is an interesting statistic.
Pregnancy counselling is about providing women with a non-directional and non-threatening service in which they can explore the issues. Some will immediately decide on their course of action, and others will still be unsure about what to do at their first appointment with a health professional. This can sometimes make it very difficult to provide the uniform standard of care that is so important. What is right for one woman will not necessarily be right for another, and so a flexible service that can respond as far as possible to individual women’s needs is essential. Moreover, we do not want to create barriers or to instil delays in the service. Counselling can help a woman to recognise conflicting emotions and feelings and allow her to accept that there may be no perfect, straightforward answer to this crisis in her life. Most importantly, it allows her time and space to reach an informed decision. There is evidence that counselling can help women, particularly vulnerable women, to make a decision with which they are comfortable. We have also heard anecdotal evidence from women who feel that they could have been helped by counselling before making their decision to have an abortion.
Counselling must be balanced. Effective counselling must be confidential, non-directive, non-judgmental, supportive and understood by the person to be independent of any assessment for legal approval for abortion. It needs to happen away from the influence of family or friends. The hon. Member for Luton South highlighted the case of a woman who felt pressurised by her boyfriend and I know that some women feel pressurised by their families.
Contraception has been free on the NHS since 1974. It has helped millions of people to avoid unintended pregnancy and to plan their families as they wish. There are 15 methods of contraception and we have seen a recent increase in the number of women choosing highly effective methods of long-acting contraception.
Although abortion rates for all ages have remained stable, between 2007 and 2010 the abortion rate fell for those aged 24 and under, and the number of abortions overall fell. In 2007 there were just shy of 200,000 abortions, whereas in 2010 there were 189,574, which is a decrease of nearly 10,000 in the space of three years. That is good, but we clearly have a great deal of work to do. Ideally, we do not want to face anything near those numbers. We must ensure that young people have good relationships and sex education so that they can make good choices for their lives.
In conclusion, this work is about ensuring that all women considering an abortion get the best possible service, which they not only need, but deserve. We are looking to build on the recent early successes of the increasing access to psychological therapies programme and to use that model to develop options for pregnancy counselling. We have had discussions with the officials leading that team in the Department and there is a lot of opportunity. I have no doubt that when we offer young women counselling, it will be an opportunity for some women to unearth all sorts of other issues in their lives, such as domestic violence and sexual abuse. I hope that all Members agree with the principle behind this, as I think they do, even though we sometimes disagree about the small print. I hope that the hon. Member for Luton South and all hon. Members will continue to work with us to get this right.
Mr David Amess (Southend West) (Con)
I congratulate my hon. Friend on the stand that she is taking, even though some of her statistics have slightly mystified me. Before she completes her speech, will she tell the House roughly when, after the consultation next January or February, she believes we will come to a new arrangement for abortion counselling?
Anne Milton
As I have said, I am working with Members on all sides of the debate to get the consultation document right, with the right options and the right offer. The consultation will last for 12 weeks and I then hope to bring forward the arrangements. There are issues with the number of counsellors who are available and with the pathways. These things never happen as quickly as I would like. I always wish that things could happen yesterday, but sadly they cannot.
Thomas Docherty
Will the Minister confirm whether she thinks that it will happen before or after the Health and Social Care Bill passes from the House of Lords?
Anne Milton
It is not for me to prejudge the passage of any Bill, particularly when it is in another place. I am determined to get on with this work. It is not dependent on the Bill. We need to move forward so that we can get the process in place for the offer to be made as soon as possible.
The hon. Member for Luton South rightly said that no one is neutral. We want women to receive advice on all the available options and to get support in making their decisions. We want them to have the offer of independent counselling so that when they make a decision, they feel sure in their hearts that it is right for them not just for today, but for the rest of their lives.
Question put and agreed to.