Complications from Abortions (Annual Report) Bill [HL]

Baroness Merron Excerpts

2nd reading
Friday 13th December 2024 Lords Chamber

[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.

Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)

Baroness Merron Excerpts

Wednesday 29th November 2023 Grand Committee

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Lane-Fox, for introducing this important debate. I particularly welcomed the focus of the committee’s report on the need for a reset, as she said, which focuses on resilience, well-being and long-term planning. I certainly share the view that all those things are needed. I hope that the Minister will find today’s debate helpful in looking forward in all those areas. I am also grateful to the noble Baroness, Lady Lane-Fox, for chairing the committee and acknowledge with thanks the contribution of everyone on the committee, including those who are present today. As the noble Lord, Lord Alderdice, said, this was not an easy time for the committee to be doing its work, so we should pay particular tribute to the members of the committee for that. I shall particularly mention one committee member, my noble friend Lord Elder, who sadly passed away recently. I am sure we all hold him in our thoughts today, and may his memory be for a blessing.

This is an interesting and important report on so many levels, not least because it makes observations and recommendations that I believe are legitimate not just when we are in crisis but when we are in the day to day. Time after time in the Chamber and outside we hear calls—I have made them myself—for joined-up government with the structures and systems to support it. I am therefore very much looking forward to hearing from the Minister, and as she is a Cabinet Office Minister, as I used to be, I will be very interested to hear from her what ongoing assessment is being made of the effectiveness or otherwise of cross-government working because, as she will know, it is only by keeping this under constant review that improvements can be made. As the report says, the pandemic was a wake-up call pointing to the need for a drastic overhaul of the approach to resilience and preparedness to be ready to face future disasters whenever and whatever they may present as.

The report states:

“It is now clear that we will never be entirely free of COVID-19 and that post-pandemic the world will be very different. Instead, we must adapt our lives”.


For some of us, that is easier than it is for others. While much of the country may be living with Covid-19, there are some 2 million people who are living restricted lives or are now in their fourth year of total shielding. Many of them are unable to make antibodies to Covid-19 and therefore the current vaccines do not serve them. This, coupled with their underlying conditions, places them at heightened risk. A recent study showed that while 4% of the population is immunocompromised, 28% of ICU admissions and 25% of deaths come from this section of the population. This is a taking a huge toll, not just on the individuals themselves but on their families, households and communities.

Can the Minister say what steps are being taken to improve the situation for those who are immuno- compromised and what they might look forward to in the future, in particular in terms of vaccinations and the appropriate medications to assist them? Perhaps the Minister could also inform noble Lords about the plans for those who are suffering the debilitating effects of long Covid—another continuing matter for so many.

I note that the Government did not respond to the report as a whole, but only to each individual recommendation. In my view, as other noble Lords have said, the Government were mostly setting out what they believe they are already doing. I feel that was something of a missed opportunity. There are some specifics that I would like to deal with: first, the underpinning issue of resilience and all that goes with it; and, secondly, some of the specific health aspects, which other noble Lords have referred to.

We have learned so much from the past few years about what it means to be a resilient society. I acknowledge that there has been progress since the publication of this report and the government response. I am sure the Minister will be advising us of this. I am glad that there has been progress because I felt somewhat overwhelmed by the sense that there was little appetite in the government response for reflection on the recommendations and for actually wanting to make improvements. Since then, however, we have seen other developments. I welcome the establishment of the Resilience Directorate and the appointment of Mary Jones, who I wish well in her endeavours leading on this.

In addition, the UK Government Resilience Framework promises a direction of travel which incorporates prevention, preparedness, response and recovery, no matter what the disaster. All these were called for in the report, so perhaps there has been some reflection since the Government responded. I am aware that the provision of vital data has also been improved. I ask the Minister: how can the data that is being used by Ministers in times of crisis also be deployed at a local level? The Minister will have heard the calls in this debate and the report for better support to localities. Does the Minister agree that the Government’s assessment of reasonable worst-case scenarios should be shared as a matter of course with local resilience forums? What plans are there for continuing core funding for LRFs?

In an Answer to a Question put to the Minister by my noble friend Lord Harris on 4 September, the noble Baroness confirmed that, in the resilience framework, it is set out that the Government have a “commitment to publishing” annual statements

“to Parliament on civil contingencies risk and performance on resilience”.

The Minister also stated that:

“Both Houses will be updated in due course regarding the timing, form and content of the statement”.

I am not aware that this update has been provided, but perhaps the Minister will confirm whether I am correct and, if so, why it is not yet forthcoming. It was also confirmed in the Answer to that Question that the Government’s intention, which was given by the Deputy Prime Minister,

“is to publish the first statement during this calendar year”.—[Official Report, 4/9/23; col. 195.]

That would happen, with both Houses being given the opportunity to scrutinise it. Clearly, there is not much of the year left. Perhaps the Minister could indicate when the first statement will be published and, if we do not see it this year, the reasons for the delay.

We are discussing this report while the Covid inquiry continues apace. Can the Minister therefore say whether and how this report might be considered alongside it? I pay tribute to all those who have worked tirelessly no matter what the emergency—in this case, the pandemic—from local councils through to the emergency services, NHS workers, carers, civil society and so many more. This begs the question of how their voices will be heard so that their experience and professionalism can inform the future.

I turn to some of the health specifics in the report. The right reverend Prelate the Bishop of London rightly referred to recommendation 1 and the fact that the government response promised a health disparities White Paper, yet we have been told that that will not happen. Many of us have pushed on this point in the Chamber. The pandemic pulled back the curtain on the fact that there are deep health inequalities in our country. The right reverend Prelate made the very good point that a more equal society strengthens our resilience. In other words, it is not an either/or but a necessity in achieving the required resilience.

The noble Baroness, Lady Coussins, spoke about a different inequality in the provision of information. How can we expect people to work with us and protect themselves, their families and their communities if they do not have access to information simply because it is not available in their language? That seems a real basic.

On health inequalities, as I am sure the Minister is very aware, living well is best captured in health policy by the concept of healthy life expectancy—the amount of time that an average person can expect to live without a major health condition. Evidence shows that the UK is no longer making progress in this regard. The poorest 60 to 64 year-olds have the same level of bad health as the richest 90 year-olds. That is a waste of 30 healthy years for those who are poorer. The impact of poverty on health means that people who live in different parts of the country have very different chances of living well. A girl born and brought up in Blackpool can expect to live well until she is 54, whereas a girl born and brought up in Winchester can expect to live healthily until she is 66. Resilience relies on those health inequalities being dealt with.

On GPs and recommendation 21, the government response is more than somewhat rosy. On access to GPs, the statistics from a recent global study by the Economist show that just one in three in the UK say that they can secure an appointment with their doctor within 24 hours. The global average is 67%—that makes the UK less responsive than Rwanda. Nearly one in five patients in the UK say that they have to wait longer than a week to see their GP. The reality of accessing general practice is not as the Government put it but at an all-time low. The noble Lord, Lord Patel, referred to media reports on the challenge of remote consultations. I say to the noble Lord, Lord Allan of Hallam, that it is absolutely not an either/or, but the noble Lord, Lord Patel, raised the right point; some people—the report talks about the very young, those with existing conditions and the elderly—may be more excluded from the benefits of remote access than others. We cannot just ignore that. What work are the Government doing to ensure that remote access brings benefits to all and does not exacerbate inequalities?

I finish by saying that the reform of the Mental Health Act could have been included in the Government’s legislative programme. The committee’s report refers to the importance of well-being and strong mental health, and a revised and strengthened Mental Health Act would have been a tremendous contribution to that. Sadly, the Government missed that opportunity, and it might be that the Minister can shed some light on when we can perhaps see some progress in this regard.

This has been a very valuable debate but, as ever with such reports, perhaps more questions are raised than the Government have hitherto answered. I hope that the Minister will take the debate in the spirit in which it is intended and perhaps use the insight of noble Lords to take us forward and to make us more resilient and prepared and to get us ready in the long term.