Complications from Abortions (Annual Report) Bill [HL]
Friday 13th December 2024
(5 days, 11 hours ago)
Lords ChamberComplications from Abortions (Annual Report) Bill [HL] 2024-26 View all Complications from Abortions (Annual Report) Bill [HL] 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Moylan (Con)
My Lords, abortion is a generally safe procedure for women. It is not my purpose in bringing this Bill forward to dispute that. Rather, the question this Bill raises is: how safe is it? To know that, we need statistics that reflect real experience.
I start by drawing attention to the excellent brief that the Library has produced. This is a debate about statistics and statistical methodology, and I do not think the complexities involved could have been set out with greater clarity than they are in this brief.
The Library brief also includes at the end certain objections to the Bill expressed by the British Pregnancy Advisory Service—although it has not in fact contacted me. The first is that the Bill exceptionalises abortion. Strangely, I think that objection gives us a way into this debate. Abortion is indeed exceptional in that it is the only common procedure that is made available by the NHS but in the great majority of cases—about 80%—is provided by independent clinics, such as the charities BPAS and Marie Stopes, although there are other smaller providers as well. That is where the statistical issues start.
Independent abortion providers provide information on terminations, including on complications arising, to the Chief Medical Officer. This is known as the abortion notification system, or ANS. It covers not only the independent sector but also the 20% of terminations carried out in an NHS setting. In the case of independent providers, the complications it captures are principally those that arise within the clinic, since many women who experience a complication after discharge from the clinic—this is a key point—will present to their GP, to NHS 111 or to A&E at a hospital. These complications are not captured by the abortion notification system.
I should add that there is a legal obligation on the Department of Health and Social Care to monitor and publish statistics on abortion, and it uses the abortion notification system for this purpose. There is an annual report published. The published rate of complications is low, generally about 1.2 to 1.4 per 1,000 in recent years, for which I have the numbers. But until recently nobody has collated figures on the level of complications not captured by the ANS data, because the complications were not reported to the abortion provider but dealt with through the NHS directly.
Last year, the Office for Health Improvement and Disparities, which is a branch or an arm of the NHS, turned its hand to this task. In November 2023—very recently—it produced its report. I have a copy here and it is a fairly chunky report. The task was more challenging than one might have thought There were, of course, many of the usual statistical conundra of what to count and what not to count, whether the definitions in different datasets were the same and matched, and so forth. In fact, the first half of the report is a careful and thorough essay on the methodology used, which is an indispensable thing to provide since it was doing it for the first time. The report focused entirely on incidents arising in a hospital setting using hospital episode statistics—I am going to use the expression HES from now on—as distinct from ANS; these are the two sets of data that we are dealing with. The report used the hospital episode statistic statistics and, importantly, did not include incomplete abortions that were not accompanied by a further complication.
There is an important argumentative point there, if I may just put some parenthesis around the next section. There is an important argumentative point between gynaecologists who would say that an incomplete abortion that was later completed was a successful abortion and others who would say that an incomplete abortion that was later completed was an unsuccessful abortion that was put right. Whether you count it as a complication or not raises issues of a definitional character between gynaecologists. The figures produced by the report did not include incomplete abortions that involved no further complication, although it did count them.
The report broke the complication rate down by age, showing what I think is generally accepted—that it is somewhat higher for older women—and by type, for example, haemorrhage, which is the most common complication, sepsis, cervical tear and so forth. The report’s headline finding was that the complication rate, when you take all the data together, was between 3.5 and 4.4 per 1,000 in the period 2017 to 2021, depending on the year, somewhat higher than the ANS data alone, and, I understand, statistically significant. However, this rose significantly to about 17, 18 or 19 per 1,000 if incomplete abortions without further complication were included.
The importance and relevance of this information is all the more significant when one considers changes in the way in which terminations are administered. Of course, a surgical abortion is now a relative rarity. Currently, about 85% of abortions are medically induced—that is, by taking a sequence of pills. In 2012, only 48% of abortions were medically induced; as I say, it is now 85%. These terminations frequently take place at home. Since the Covid pandemic, it is possible for a woman to obtain the medication from an abortion provider without an initial in-person interview or examination. What this shows is that the abortion landscape is shifting quite rapidly. Clinicians need to have available the most robust data about complications, indeed as women do for the purpose of informed consent. It is unfortunate, therefore, that it appears that there are no plans for the OHID to continue to collect the valuable data contained in its report of November 2023. My Bill would place an obligation on the Government to do so.
Turning to the Bill briefly, I note that Clause 1 does a number of things. It requires the Secretary of State to publish an annual report on complications. It states that the purpose is to inform policy and safe practice. It requires the inclusion of data from both the ANS and the hospital episode statistics. It specifies that the report must cover the same areas of information as the 2023 report. It gives the Secretary of State power to add further information that he or she sees fit to include, and it states that the first report must appear within a year.
Clause 2 covers territorial scope and commencement. In effect, the Bill applies to England. There is no other clause.
Before I sit down, perhaps I may deal briefly with some objections. First, I return to the comments of the British Pregnancy Advisory Service. I dealt with its claim that the Bill “exceptionalises” abortion. Abortion is exceptional; it is a very unusual way of providing a health service in this country. Its other comments seem to me to be rather weak. I think the key point is that it too agrees that
“further work needs to be done on collection and analysis of large datasets relating to women’s reproductive health”.
Nobody really defends the existing ANS statistical sets on their own as giving a realistic picture. BPAS also claims that there are better ways of deal with the problem than this Bill. That may well be true, but it does not suggest what they are.
I shall mention one further objection, and then I shall sit down. It may be said that an Act of Parliament is a bit of a sledgehammer to crack a nut if all one is looking for is an annual report. I see the force of that objection, while still supporting and sustaining my Bill, and if the Minister were to give a firm undertaking to do this without the bother of a statutory obligation, I should be well content. I beg to move.
Baroness Barker (LD)
My Lords, I am going to take the opportunity to explain the context of the Bill and say what it is really about. In doing so, I thank the noble Lord, Lord Moylan, for yet again giving me the opportunity to draw your Lordships’ attention to the right-wing, nationalist, countergender campaign which this Bill and his previous foetal sentience Bill are a part of. We have known for some time that there is an international campaign which has an overriding strategic objective of getting rid of human rights legislation and the organisations responsible for upholding it.
On a tactical level, it has a number of objectives: anti-LGBT campaigning—with a particular emphasis in this country on anti-trans work; anti-sex and relationships education, because the state should have no part in teaching people’s children about sex and relationships; anti-surrogacy, and particularly anti-abortion. People may have read or seen, most notably, the campaigns in places such as Hungary and Poland. It is all about a campaign to restore the natural order—a selective reading and interpretation of biblical order.
When I have said that in this Chamber before, Members of your Lordships’ House have thrown the jibe, “Well, that sounds like a conspiracy theory”. Well, it is not actually, and we have some growing evidence to that effect. I encourage all noble Lords to read Project 2025—it is a very easy and clear read. It says what the organisations behind it, such as the Heritage Foundation, the Alliance Defending Freedom and big supporters of the Conservative Party in this country have as their agenda for the Trump Administration. It is all backed up by billions of dollars going to Africa and billions of dollars coming to Europe including to the UK. It is a campaign which has evolved, just as the anti-abortion campaign has evolved from rather crude demonstrations outside abortion clinics; it has now gone into a slightly different phase. It is now setting up independent universities and colleges; it is producing research evidence; it talks using the language of rights, but all the conclusions go back to that same overall objective. It is very clever, very well organised and brilliantly messaged, but it is what it is: it is a very cynical anti-gender campaign about destroying human rights.
This Bill is an insidious part of that campaign. It is about challenging the medical evidence that does not suit its campaign objectives. I, like other people on my side of the argument, am all in favour of collection and improvement of data. What I am not in favour of is the corruption of medical science by the production of data for a purpose. That, I suggest, is the ultimate aim of the Bill in the name of the noble Lord, Lord Moylan. Therefore, I hope that noble Lords will not be taken in by this, will see it for what it is and work with people such as those at the Royal College of Obstetricians and Gynaecologists who want to improve the data and to make sure that our services are safe for women.
Baroness Foster of Aghadrumsee (Non-Afl)
My Lords, I commend the noble Lord’s Bill to the House. It offers a moderate proposal that ought not to be controversial. Whatever one’s view on the issue of abortion, it is clearly in the interests of public health and patient safety to ensure that accurate data is collated and reported concerning the scale and nature of complications from abortions, as with any medical procedure. As the noble Lord has explained, current reporting is deficient and has not caught up with the changes concerning how an increasing number of abortions now occur.
As well as supporting the comments that the noble Lord has made, I wish to make two further points in relation to the Bill in the short time available to me. First, I note that while the 2023 Department of Health publication on which the Bill is based records data more accurately than previous reporting, it acknowledges in its own annexe that it does not include complications under the code O044. That code records “incomplete” abortions, where part of the unborn baby remains inside the mother after an abortion.
That report includes hospital episode statistics relating to incomplete abortions where they have led to additional complications but not to incomplete abortions themselves. However, given that any incomplete abortion routinely requires further treatment to remove the remaining parts of the baby to avoid the risk of infection, it seems to me that those also ought to be included in any accurate recording of statistics.
The second point I want to make is in relation to Northern Ireland, as all noble Lords would expect. While I understand that the Bill relates to England in order to correspond to the November 2023 report, I would like to see an improvement in data collection and reporting in Northern Ireland. Since abortion was decriminalised in Northern Ireland, reporting on abortions has been woefully inadequate. Indeed, we appear to have even less data concerning complications than the limited data published in England.
The regulations attached to the Northern Ireland abortion law require abortion providers to report
“Particulars of any complications experienced by the woman up to the date of discharge”.
That means we have the same problem as in the rest of the UK, because complications which arise after discharge, and which come to light in a hospital setting only when a woman seeks further treatment, are unlikely to be recorded in official statistics. It would be really good if we had better information and data in Northern Ireland, as here in the rest of the UK.
Data informs health trends; it gives transparency and understanding, but, above all, it ensures patient safety. The purpose of this Bill is to have accurate data, and I am very happy to support it.
Lord Frost (Con)
My Lords, it is a pleasure to follow the noble Baroness, Lady Foster, who spoke, as she always does, powerfully, compellingly and rationally—it is important keep that rational focus on this important Bill. I thank my noble friend Lord Moylan, who set out the rationale for it clearly, compellingly and in some detail, and I am delighted to have this opportunity to support it.
Whatever one’s views on the substantive question of abortion, I find it hard to see why we would not want as much information as we could possibly get on this question, especially when, as my noble friend Lord Moylan noted, there is clear evidence for at least a potential anomaly that needs addressing in the statistics. It is surely in the interests of any woman considering an abortion to have the best possible information about the possible risks involved.
In the short time available, I want to make one further point to those that have been made already, on the objection from the British Pregnancy Advisory Service—which the noble Lord, Lord Moylan, has already noted—that this Bill would in some way “exceptionalise” abortion. I find that worthy of a brief comment. As the noble Lord said, abortion is already exceptional in various ways. One might note in passing that it is the only form of healthcare that has required the suspension of free speech rights—and even non-speech rights, those of free thought—to allow it to be transacted. Passing on from that, more substantively, it is exceptional because it is one of those areas of care where there really are starkly clashing worldviews. I am sure that we will hear much more about that later on this morning. That means that it always is going to be subject to debate, unless there is some fundamental change in the ethical basis of our society. Therefore, ways through have to be found, in a free society, to accommodate that.
The need for debate around abortion provision will, and I think should, always make it exceptional. It means that we need that debate to be as well-founded as we can possibly make it—well-founded in the moral judgments that we bring to it and well-founded in having the best possible information and analysis around it at a technical level. That is what this Bill would help to provide, and that is why I support it.
Baroness Bennett of Manor Castle (GP)
My Lords, in following the noble Lord, Lord Frost, I stress how important the Green Party and many other people regard protecting those receiving healthcare from harassment and abuse. That is something that the law has increasingly stepped up to do, and it is terribly important.
I oppose this Bill. I begin by commending the speech of the noble Baroness, Lady Barker, who gave us an important sense of context here. This is about a very long-term, global, but US-based, exceptionally well-funded campaign against human rights. Back in 2014, I wrote a chapter in a book entitled Women Against Fundamentalism: Stories of Dissent and Solidarity, which told the story of what happened in the 10 years leading up to where we are today.
I will focus a little on context. It is important to note that, last year, YouGov looked at attitudes towards abortion and found that 87% of Britons said that abortion should be allowed, while only 6% said that it should not. It is interesting to note that one in 10 Britons think that the law makes it too difficult to get an abortion in the UK. When you look at those for whom this is most relevant—women under the age of 40—you find that that figure rises to 19%. Those are the people who are most likely to encounter the detail of the law and to have discovered, as many are surprised to, that abortion is covered by criminal law still in the UK. It is important to highlight that.
As we talk about abortion, one issue is the rise we have seen in the investigation and prosecution of what is suggested might be illegal abortions. In the 18 months to February, there was a risk of convicting as many women as have been convicted for that offence in the previous 55 years. Six women were prosecuted over suspected abortion cases, although three of those cases were subsequently dropped—the women having been through very considerable turmoil in the meantime. The president of the Royal College of Obstetricians and Gynaecologists has noted how outdated abortion law really is creating problems. That is the context.
We have already covered quite a bit of ground here. It is obvious that creating a law about one set of medical statistics is exceptionalising it, as BPAS says. In 2023, three years of work went into a report then that said that the statistics were inadequate and needed to be improved. The work is being done; we do not need to pass a special law on one set of statistics. We are making progress on this, and more progress is certainly needed.
Baroness Lawlor (Con)
My Lords, I speak in favour of my noble friend’s Bill. I am a great supporter of patient empowerment, and one sure way to give patients power is to arm them with knowledge and the medical options available to them. Recently, I had a hand procedure for Dupuytren’s disease. In the run-up to the procedure I wanted to know all the evidence available about the condition itself, the treatment, the options, the aftercare, and indeed the complications. I did so partly by talking to a GP and other doctors I knew, but partly by looking at websites.
This simple measure, proposed by my noble friend Lord Moylan, for a report that collates both sorts of data—that from the hospital episodes statistics and that from the ANS—will provide a fuller picture for people like myself. More importantly, it will strengthen the channels of information on the complications arising from abortion. While the annual published statistics may not be read by many people, and rely solely on the ANS data, note will be taken of a report issued by the NHS that collates the full information, both from the medical press and GPs. Levels of public information about possible complications and potential risks will be available. Because the role of medical practitioners in advising about any procedure is rightly deemed central, it is important that, as a result of the measures proposed in this Bill, they will be better informed.
My mother was a doctor. My abiding recollection of her is that, every night, at the end of the day when her chores were done, she would pick up her medical journals and updates on all medication available to keep herself up to date with the latest evidence and research, in an otherwise very busy day. That was what she anticipated doing each night, and she was bang up to date on treatments and everything to do with her work.
Not only that, but an annual report could be read by people themselves, especially if they want to follow up on one or other point of the medical advice. Professionals can disagree among themselves about how they interpret the evidence—we heard from my noble friend Lord Moylan one example of how gynaecologists can disagree over even a definition. It would be very helpful for people to see such a report for themselves; this is particularly so in the case of sensitive subjects.
For all those reasons, I support requiring an annual report on the complications such as that proposed in the Bill, which is along the lines of the 2023 report by the NHS. I wholeheartedly support my noble friend’s Bill.
Baroness Miller of Chilthorne Domer (LD)
My Lords, this is not my area of expertise. Like the noble Lord, Lord Moylan, my background is in local government and business. Unlike the noble Lord, Lord Moylan, I do not think that we should be passing legislation on which areas of health we should collect data on. Certainly, we should collect the data, and certainly our job in this House is to question inconsistencies, but it is not to legislate for them.
The noble Lord, Lord Moylan, criticised the British Pregnancy Advisory Service for talking about “exceptionalism”. In fact, at the heart of this Bill there is an illogicality. It tries to collect data just on the abortions and is not looking at the complications—for example, of women having to carry to term babies that, for a multitude of reasons, they would have chosen to abort.
On the face of it, this is a very logical Bill, but I am grateful to my noble friend Lady Barker and the noble Baroness, Lady Bennett, for laying out the context and background. When I looked at the last Bill from the noble Lord, Lord Moylan, on sentience, I got a clue as to where he is going with this whole thing. That is why I have chosen to speak briefly today.
I deeply believe in a woman’s right to choose what she does with her body. Women’s rights, as the noble Baroness, Lady Hodgson, said when she was talking about her Bill on peace, are being rolled back across the world and it is our job to make sure that we uphold them. It has taken centuries to get to a place where back-street abortions are a thing of the past in this country, and I do not wish to see us make any move that makes us arrive at a place of less safety. It took so much effort to get women to a place of greater safety and we must stop any attempt to reverse that.
Baroness Sugg (Con)
My Lords, the goal of improving women’s healthcare through better access to information, particularly regarding potential complications of medical procedures, is indeed important. Access to information enables individuals to make informed choices and allows healthcare professionals to provide safer, more effective services. However, while I support the overall goal, I have concerns about legislating for an annual report in this manner.
First, as we have heard, it is important to emphasise that abortion is a safe and effective medical procedure and, in fact, can be safer than continuing a pregnancy to term. While any medical procedure carries some risks, those associated with abortion are well managed and women are fully informed of them by healthcare professionals, ensuring that they are equipped to make the best decision for their own health. I agree that improving this data collection is crucial. As highlighted by the Royal College of Obstetricians and Gynaecologists, the lack of effective data has hindered innovation and improvement in women’s healthcare and, ultimately, the improvement of patient care. However, as we have heard, BPAS and the royal college have significant concerns about the Bill’s potential to exceptionalise and stigmatise abortion care.
Unlike other medical procedures, abortion would be singled out for mandatory complication reporting. No other procedure is subject to this. Doing so for abortion could create a false impression that it is uniquely dangerous. In reality, complications from abortion are rare—
Lord Moylan (Con)
It is already mandatory for complications from abortions to be reported. If that is exceptional, it is not made more so by this Bill. The question is from which data source one draws the reporting of those complications. They are reported and published every year by the department; this would not put a new requirement on abortion reporting.
Baroness Sugg (Con)
My Lords, as I say, I am very much in favour of ensuring that information is fully available, but I am concerned about having primary legislation singling out one medical procedure. It could promote fear and concern around women and make them feel as though they are not able to make their own choices around healthcare. It should be regulated like any other medical procedure. By treating it differently, we could add stigma. It is important to consider this in the wider context of the current politicisation of the abortion debate around the world.
We have heard about the difficulties of collating and collecting this data. Collating the current available data does not give an accurate picture. These issues were highlighted in the 2023 report. I would be interested to hear from the Minister about the department’s experience of collating the report: whether she thinks it is the best use of resources and indeed whether it led to any practical action that has improved healthcare.
The current reporting systems are far from perfect. We also have to be careful about when we link records, because that is not always desirable. Many women, especially those facing domestic violence or reproductive coercion, may not want their procedure recorded. Confidentiality is crucial for safety. A lack of privacy could deter women from seeking care, putting them at greater risk. For that reason, I cannot support the Bill as it stands.
I agree that improving data collection within women’s healthcare is essential, but that can be achieved in ways that respect privacy while improving care. The NHS 10-year plan and the women’s health strategy update offer a good opportunity to address these challenges effectively, without adding unnecessary legal burdens on the healthcare system. As we look to enhance women’s healthcare, we must proceed carefully and sensitively, balancing data collection with privacy and choice for women.
Lord Scriven (LD)
My Lords, I thank the noble Lord, Lord Moylan, for this Bill. He may not realise that he has highlighted an important issue that needs to be addressed—not the limited and, I may say, misguided focus of this Bill, but the wider issue of robustness of health datasets and the reliability of statistics used to plan, improve and deliver safe services as part of our healthcare system. As a former health services manager, I have taken an interest in this for a long time.
The NHS is one of the most data-rich healthcare systems in the world, yet some of its datasets suffer from weaknesses that can impede its ability to deliver high-quality, data-driven care. These weaknesses can broadly be categorised into areas of data quality, interoperability, accessibility and governance. One of the fundamental challenges lies in the inconsistency and incompleteness of data. NHS datasets often include outdated, duplicated or incorrect information due to variations in how data is recorded across trusts and practices. For example, patient demographics, diagnosis or treatment codes and records might be inconsistently documented, making it difficult to draw accurate insights. This runs into thousands of conditions and treatments, not just this one, which I hazard an educated guess has not been randomly plucked for the attention of this Bill. When you add in the private sector, it becomes near impossible to provide a complete patient journey through statistics to help improve patient care.
If the noble Lord, Lord Moylan, and his supporters want to improve healthcare outcomes for not just women but everyone, and safety and policy built on better data, their Bill should focus on legislating to improve data quality in the NHS. It should be about adopting national standards for data quality, promoting interoperability, enhancing accessibility, strengthening governance and transparency and leveraging advanced analytics. So why pick out just one treatment among thousands with poor and conflicting data in our healthcare system and make the exception of trying to report it to this Parliament? The noble Lord’s reason for exceptionability does not stand up: 55% of ophthalmology cases are provided by the private sector and 30,000 hip replacements are provided by the healthcare sector.
This Bill is a back-door attempt to limit abortion in this country, using statistical jiggery-pokery as a smokescreen. I say sorry to the noble Lord and his supporters, but this just will not wash. The real motives need to be exposed. It is telling that the majority of those actively campaigning for this Bill are the very organisations that are prominent in attempts to restrict or, in some cases, ban abortion in this country.
These Benches will support genuine and effective measures to improve datasets in our healthcare system, to improve safety and outcomes for not just women but all patients, but we will not support the ideas of this Bill, which are not a foundation for effective improvement in healthcare and healthcare safety. We need to be clear: this Bill will not deal with the underlying weaknesses of healthcare datasets. It is the first step in an agenda to restrict women’s choice and, in some cases, restrict abortion altogether.
Lord Sandhurst (Con)
My Lords, this Bill performs an important service. It highlights the absence of accurate, comprehensive statistics in respect of abortions. My noble friend Lord Moylan is to be congratulated on his clear exposition of the complex issues involved. I am also grateful to the Library and the Royal College of Obstetricians and Gynaecologists for their briefings.
The Department of Health has highlighted that the statistics on complications from abortion should be treated with caution, particularly following changes to the way that medical abortions are permitted to be carried out. It has explained that it is not possible fully to verify complications recorded on the relevant HSA4 forms. Complications that occur after discharge may not always be recorded.
My noble friends Lord Frost and Lady Lawlor have highlighted the importance of good data. In April 2021, the Government acknowledged limitations with the data provided on the HSA4 forms. The Office for Health Improvement and Disparities then undertook a project to review the system of recording abortion data to address the limitations of the data on complications recorded on the HSA4 forms.
OHID acknowledged limitations with data collected through the HSA4 form on the abortion notification system, otherwise known as ANS. Abortion complications are recorded differently in hospital episode statistics—HES—compared to the ANS. Each data source has different strengths and limitations, according to the experts. Neither data set would, however, include complications diagnosed by a GP, the 111 service or an A&E department. The OHID publication did not make any recommendation as to whether HES data should be used to supplement ANS data in the future, and they are the experts.
The royal college argues that lack of effective data collection has held women’s reproductive healthcare back in its ability to innovate and improve, and that that is to the detriment of patient care and experience. The royal college submits that data collection must be improved within women’s healthcare and that abortion should be treated and regulated like any other medical procedure. None the less, as it points out—and as I understand—in no other area of healthcare, outside of abortion, does primary legislation impose a duty on the Secretary of State to produce an annual report of complications data.
We on this side of the House fully recognise the power and benefits of transparency of data to the public and within the Government, and my noble friend has highlighted these powerfully. However, we are not fully convinced that primary legislation is the best practical, or most appropriate and proportionate way forward, to achieve the transparency he seeks. My noble friend Lady Sugg also made the same point and pointed to the sensitivity of patient confidentiality in this field. I have highlighted the challenges of collecting data consistently and robustly in this field. Some of those appear to have emerged from the 2017-21 data that was published. While we appreciate what my noble friend seeks to achieve, I hope the Minister will be able to set out how the Government propose to deliver the greater transparency of data that my noble friend seeks through the Bill.
In summary, our view is that improved data collection and reporting does not need to be delivered through legislation, but we urge the Government to do more to rationalise data recording and collection so that proper evidence-based medicine can be implemented. The Government must take steps to ensure data are gathered on a more reliable and consistent basis; the same should apply in this field as across all health aspects in this country. Those responsible for the health of women must do much better; the department must get a grip and give a lead.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Members’ Bill, and all noble Lords for their contributions. For my part, I am looking at the main purpose of the Bill, which is to impose a legal duty on the Secretary of State to
“publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”.
I note that the purpose of the annual report is
“to inform policy and safe practice regarding the termination of pregnancy”.
Of course, this Government are entirely committed to safety being a top priority. However, the Government have also expressed reservations about the Bill on the basis that, as many noble Lords have said, legislation is not needed. My feeling, in listening to the debate, is that the Bill is something of a solution in search of a problem. The aims of the Bill can be achieved through existing routes—as the noble Baronesses, Lady Sugg and Lady Miller, among other noble Lords, indicated—and further legislation is unnecessary. I know that noble Lords completely understand the need to uphold a duty of care not to legislate when there are other reasonable processes in place.
As we have been reminded, the context in which we are having this debate is that abortion in Great Britain is governed by the Abortion Act 1967. I appreciate it is not in the Bill but, having listened to the debate—and the context given by the noble Baronesses, Lady Bennett and Lady Barker—any change to the circumstances under which abortion can be legally undertaken is a matter of conscience for individual parliamentarians, rather than for the Government. The Government follow the will of Parliament.
On the matters highlighted in the Private Members’ Bill, I agree with the noble Baronesses, Lady Sugg and Lady Bennett, and other noble Lords, that abortion continues to be a very safe procedure in which major complications are rare at all gestations. This has been supported by existing data and clinical guidance from the National Institute for Health and Care Excellence, NICE, and—as has been referred to a number of times already—the Royal College of Obstetricians and Gynaecologists.
It is a legal requirement that all terminations performed under the Abortion Act must be notified to the Chief Medical Officer within 14 days of the procedure. These notifications are submitted via HSA4 abortion notification forms and the abortion notification system. Complication rates by procedure and gestation, as routinely recorded by that system, are published as part of the abortion statistics report for each calendar year. According to the HSA4 notifications submitted in 2022, complications were reported in 1.2 per 1,000 abortions in England and Wales.
The abortion notifications submitted to the Chief Medical Officer record known complications, as raised a number of times in the debate, up until the time of the patient’s discharge from the abortion service. Complications that occur after discharge are not required to be recorded on HSA4 notifications and I suggest that it would present a complete impracticality to do so. Complications are also recorded in other patient record systems such as hospital episode statistics, where the woman has been admitted as an inpatient. Of course, serious incidents have to be notified to the CQC.
On the specific point about the annual report, the comparison publication was never intended to be a part of the then-Government’s routine publications and, in keeping with this, we have no plans to issue a similar publication annually. In answer to the noble Baroness, Lady Sugg, it is not believed—and clearly the previous Government did not believe, beyond producing one report—that this is a good use of resources, nor that it adds anything to patient safety. That, as the noble Lord, Lord Scriven, rightly reminded us, is exactly what we are here for.
I have heard the noble Lords, Lord Frost and Lord Moylan, along with other noble Lords, and while they have not used this word, I feel that they have taken exception to it being said, “this Bill would exceptionalise abortion”. I emphasise—as the noble Lord, Lord Scriven, and others did—that no other complications from NHS procedures are separately required to be published through legislation. I am afraid I cannot call that anything other than exceptionalism towards abortion in this instance. However, I can give the assurance to your Lordships that we continue to work with providers and commissioners to ensure that abortions are delivered safely, in accordance with the Abortion Act, and that complications are recorded accurately as required.
We are inviting views on abortion statistics for England and Wales, including the future publication of abortion complications data, via an online user engagement survey and via email. In other words, we are not complacent; we are always seeking to improve.
The noble Baroness, Lady Foster, asked about data on abortion in Northern Ireland. It is collected by the Department of Health in Northern Ireland because, as I know the noble Baroness is aware, it is a devolved matter. The noble Lord, Lord Moylan, asked why there is not a recording of what were referred to as incomplete abortions. For the abortion notification system, the HSA4 form explicitly states that
“an evacuation of retained products of conception is not a complication”,
and therefore they are not included in the ANS complication rates.
I absolutely share the passion of the noble Lord, Lord Scriven, for improving NHS data provision across the board, and I am glad to assure him that this will be an integral part of the 10-year health plan. To the noble Baroness, Lady Sugg, I say that the existing ANS is used to ensure that patients are receiving safe and appropriate care, as abortion tends to be provided by private providers. That data can be helpful to ensure that it is delivered safely and effectively, but it is our view that we do not need any further statistical reporting—and certainly not in the way described in the Bill—because, as I emphasise, I believe this would exceptionalise abortion without adding to patient safety. I am glad to welcome the comments of the noble Lord, Lord Sandhurst, who is as committed to that as all noble Lords in this House.
The Government have expressed reservations about this Private Member’s Bill. This is an unnecessary process: mechanisms already exist, it will not add to patient safety, and it is therefore not appropriate to legislate further.
Lord Moylan (Con)
My Lords, I am very grateful to all noble Lords who have spoken in this short debate. My noble friends Lord Frost and Lady Lawlor made important points about patient empowerment, but also about the improvement in medical care that can only follow from a better understanding of what is actually going wrong.
I am also partly grateful to the noble Baroness, Lady Miller of Chilthorne Domer, because she supported the principle that the data should be collated—she thought perhaps not by means of an Act of Parliament. I conceded that point in my opening remarks—there are other means of doing it—but she said that she thought the data should be collated.
I find myself less able to express gratitude to the noble Baroness, Lady Barker, who lives in a world that I simply do not recognise. I have not read the American book she referred to. She came dangerously close to suggesting that I was either in receipt of or being influenced by money for this purpose. That would be a contemptible thing to say, and I will happily give way if she indicates that she wishes to distance herself from any such implication.
My noble friend Lady Sugg said that the Bill required abortion complications to be reported for the first time, and that this would be different. It does not. Abortion complications, as the Minister said, are already reported. The question is whether the data is robust and the sources from which it is drawn. My noble friend also said that collecting data could compromise the privacy of patients. Well, of course it could, but it does not, because you collect it without compromising the privacy of patients. Nobody has suggested that the report produced in November 2023 remotely compromised the privacy of patients. All that the Bill does is require that this report continue to be produced on an annual basis.
The noble Lord, Lord Scriven, was massively keen to improve the quality of NHS data, but the moment he sees a report from the Office for Health Improvement and Disparities, which clearly improves the quality of data, he retreats into a sort of conspiracy theory.
Lord Scriven (LD)
If you are going to have end-to-end patient data, it needs to include A&E, GP, private, in-patient and out-patient. The statistical analysis that the Bill puts in place is a complete gap and does not give end-to-end patient data. Therefore, it becomes a totally ineffective use of statistics.
Lord Moylan (Con)
With respect, it is true that the report, which the noble Lord has obviously read carefully, does not include data from GPs or from 111. That would have been an onerous task and, as the Government have said, this was a first and experimental effort. This is an argument for going further and improving the collection of that data, not for giving up the attempt altogether and seeing it as a conspiracy, which is what the noble Lord appeared to do.
We are really all on one page about this—or at least he and I seem to be. What is so strange about the advocates of choice in this debate is that they are so defensive; they speak as if they are surrounded by conspiracy. I do not actually think they are. If I thought I was surrounded by conspiracy, I would want to live in a world of facts and not hide myself from them, which is what they seem to be doing. The proposal is that data produced by an arm of the NHS should continue to be produced, whether by statutory or administrative means. That is all it is.
I know that there are other things happening today, so I turn finally to the remarks of the Minister. I am grateful to her for being one of the few people to treat the Bill seriously and to look at what the words in it say. She wandered slightly from that into the worlds of strange contexts, but in fact a great deal of her speech was an echo of my speech. On the history and the factual and contextual issues here, we are largely agreed. I agree that the Bill exceptionalises abortion to some extent because, as I said, abortion is exceptional, in that its statistics are generated from different data sources, which is very different from the majority of NHS procedures that take place inside a hospital. I grant that the noble Lord, Lord Scriven, has a point that there are other exceptional cases. I did not say that abortion was unique; I said it was exceptional. There are differences between the two words, and he is right about some hip operations and so forth taking place in the private sector, where similar issues might arise as well.
The Minister says that there are different and other ways of collecting these statistics: non-statutory means. I conceded that point, too, in my opening remarks. What she did not say is that she would use a different, non-statutory means of collecting these statistics. I remind her that when she signs her letters, underneath her name it says: “Minister for Patient Safety and Women’s Health”.
We need better statistics on complications arising from abortions. I am disappointed that the Minister has not committed herself to that and agreed that, even if a Bill is not necessary for this purpose, she will set herself to do so. Sadly, she has not.