Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how many abortion clinics run by (1) the British Pregnancy Advisory Service, (2) MSI Reproductive Choices, and (3) National Unplanned Pregnancy Advisory Service, have (a) never been inspected by the Care Quality Commission, and (b) not been inspected in the past three years.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The following table shows the number of abortion clinics which have never been inspected by the Care Quality Commission (CQC), as well as the number of clinics which have not been inspected in the past three years:
Name of provider | Have never been inspected | Have not been inspected in the past three years |
British Pregnancy Advisory Service (BPAS) | 0 | 6 |
MSI Reproductive Choices | 3 | 6 |
National Unplanned Pregnancy Advisory Service (NUPAS) | 4 | 2 |
Source: Care Quality Commission
There are four NUPAS clinics that do not have any rating. This is because these were registered in the last 12 months.
There are three MSI Reproductive Choices clinics that do not have a rating. Two of these clinics do not have a rating because they were registered in the last 12 months. One of these clinics was registered nearly two years ago but has not yet had an inspection. This is because the transition to the Single Assessment Framework (SAF) has delayed inspection in some cases.
Under Section 46 of the Health and Social Care Act 2008, the CQC must update the health and social care sectors as to how frequently they will assess the providers they regulate. The CQC plans to publish an interim statement in August 2024 about how frequently they plan to assess each type of service.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what analysis they have undertaken in either of the last two Parliaments of the fiscal implications for the National Health Service and the wider economy of any liberalisation of end-of-life care and assisted dying.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
No assessment has been made of the fiscal implications for the National Health Service, or the wider economy, of any liberalisation of end of life care and assisted dying.
Integrated care boards (ICBs) are responsible for commissioning palliative and end of life care services that meet the needs of their local populations. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications for adults, and children and young people.
Assisted dying is an extremely sensitive issue with deeply held views on both sides of the debate. A vote on any change to the law of England and Wales in this area is a matter for Parliament to decide. It is reasonable to have a discussion on what is an important topic, and it is right that we locate that question within a broader context of how we care for people at the end of their lives. Should the law on assisting dying change, the Government would work with stakeholders to ensure that safeguards were in place, and that the law is enforced in the way that Parliament intended.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 15 May (HL4224), how they reconcile the answer with that given by the Parliamentary Under Secretary of State for Health and Social Care on 23 November 2023 (HC527), which precluded the ability of a medical practitioner to form a "good faith" opinion through a telemedicine consultation alone that the patient's gestation was below 10 weeks, and therefore to dispense early medical abortion pills for use by the patient at home.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The response of 23 November 2023 does not preclude the ability of a medical practitioner to form a good faith opinion, through a telemedicine consultation alone, that the patient's gestation was below 10 weeks. This opinion can be formed either during a teleconsultation, or an in-person appointment.
Pregnancy duration can be assessed from the first day of the last menstrual period (LMP). Advice from the Royal College of Obstetricians and Gynaecologists is clear that most women can determine the duration of their pregnancy with reasonable accuracy by LMP alone.
However, if there is any uncertainty about the gestation of the pregnancy, the medical practitioner would ask the woman to attend an in-person appointment to enable them to form an opinion that the pregnancy will not have exceeded 10 weeks at the time the first abortion pill is taken. If she does not attend in-person when requested, the terminating practitioner would not be able to form an opinion in good faith that the pregnancy is below 10 weeks gestation, and therefore would not be able to prescribe abortion pills for home use.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 9 May (HL4286), whether they have issued guidance to telemedicine providers about complying with the prohibition of termination of pregnancy at gestations over 10 weeks outside a National Health Service facility or an approved place; and if not, why.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
No specific guidance has been issued, however, all abortion providers are aware that termination of pregnancy in England and Wales can only be provided within the legal framework laid down in the Abortion Act 1967.
The legal framework for home use of early medical abortion pills is set out in the Department’s guidance, Abortion: procedures for the approval of independent sector places for termination of pregnancy (abortion) in England. This guidance applies to independent sector abortion clinics and states that the Abortion Act 1967 allows women having an abortion during the first 10 weeks of pregnancy, specifically up to nine weeks and six days gestation, to take one or both medicines for an early medical abortion at home. It also highlights that women having an early medical abortion at home should be given information on the implications, health and otherwise, of taking the abortion medicine beyond the legal limit of nine weeks and six days gestation.
In addition, the National Institute for Health and Care Excellence’s guideline on abortion care, to which all abortion providers are expected to have due regard, highlights that women who are having a medical abortion and will be taking the first pill, mifepristone, up to and including nine weeks six days gestation, can be offered the option of expulsion at home.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to address complication rates identified in the Office for Health Improvement and Disparities statistics published 23 November 2023 (1) for women under 20 in home and clinical settings, and (2) for those who had abortions after more than ten weeks gestation in a clinical setting.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Department’s comparison of statistics on abortion complications in England, using data from the Abortion Notification System, compared to data on hospital admissions for abortion complications from Hospital Episode Statistics for the years 2017 to 2021, found that women under 20 years old had the lowest complication rates of any age group.
Abortion continues to be a very safe procedure for which major complications are rare at all gestations. However, it is known that the risk of complications increases at higher gestations. The Department works closely with NHS England, the Care Quality Commission, and abortion providers to ensure that abortions are provided safely, in accordance with the legal framework set by the Abortion Act 1967.
It is a legal requirement under the 1967 Abortion Act that the Chief Medical Officer must be notified of all abortions within 14 days of the procedure. The Department provides the HSA4 abortion notification form for this purpose. HSA4 forms record known complications, up until the time of the patient’s discharge from the abortion service.
To consider the completeness of abortion complications data submitted via abortion notifications, the Department committed to publishing a one-time analysis comparing data from the Department’s Abortion Notification System and the Hospital Episode Statistics. This was published in November 2023. The Department is 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. We welcome responses from abortion providers and all interested parties on this matter.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure statistics on abortion complications are accurately collected and analysed to develop policies to improve women's health.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Department’s comparison of statistics on abortion complications in England, using data from the Abortion Notification System, compared to data on hospital admissions for abortion complications from Hospital Episode Statistics for the years 2017 to 2021, found that women under 20 years old had the lowest complication rates of any age group.
Abortion continues to be a very safe procedure for which major complications are rare at all gestations. However, it is known that the risk of complications increases at higher gestations. The Department works closely with NHS England, the Care Quality Commission, and abortion providers to ensure that abortions are provided safely, in accordance with the legal framework set by the Abortion Act 1967.
It is a legal requirement under the 1967 Abortion Act that the Chief Medical Officer must be notified of all abortions within 14 days of the procedure. The Department provides the HSA4 abortion notification form for this purpose. HSA4 forms record known complications, up until the time of the patient’s discharge from the abortion service.
To consider the completeness of abortion complications data submitted via abortion notifications, the Department committed to publishing a one-time analysis comparing data from the Department’s Abortion Notification System and the Hospital Episode Statistics. This was published in November 2023. The Department is 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. We welcome responses from abortion providers and all interested parties on this matter.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by the Parliamentary Under-Secretary for the Department of Health and Social Care on 14 November 2023 (HC527), whether they intend to publish an updated version of the Department for Health and Social Care guidance on completing the EMA1 abortion form or similar certificate, to reflect the fact that the good faith opinion of the medical practitioner as to the patients’ gestation period can no longer be relied upon if an in-person consultation has not taken place.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
There are no plans to publish an updated version of the Department’s guidance on completing the EMA1 abortion form, or a similar certificate, before early medical abortion pills are prescribed for use in a pregnant woman’s home.
In line with the guidance, the EMA1 form, or a similar certificate, must be completed by the registered medical practitioner terminating the pregnancy. This is to certify their opinion, formed in good faith, that if the medicine prescribed for the termination of the pregnancy is self-administered in accordance with their instructions, the pregnancy will not exceed 10 weeks at the time when the first pill, mifepristone, is taken.
This opinion can be formed either via a teleconsultation, or at an in-person appointment. Most women can determine the duration of their pregnancy with reasonable accuracy from the first day of their last menstrual period alone. However, if there is any uncertainty about the gestation of the pregnancy, the medical practitioner will ask the woman to attend an in-person appointment to enable them to form an opinion, in good faith, that the pregnancy will not have exceeded 10 weeks at the time that the first pill is taken.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what guidance they have issued to medical practitioners dispensing telemedicine abortion pharmaceuticals to patients who are more than ten weeks pregnant.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
Whilst no specific guidance has been issued, the 1967 Abortion Act is clear that treatment for termination of pregnancy at gestations over 10 weeks can only be performed in a National Health Service facility or a place approved for this purpose by the Secretary of State for Health and Social Care.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to remarks by Lord Markham on 22 March (HL Deb col 441), what is the legal or evidential basis of his assertion that the Government has a “duty of care not to legislate where other reasonable processes are available” and where this is further enunciated.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
When considering its approach to legislation, in all cases the Government must be guided by whether the aims of that potential bill can already be implemented through other reasonable and established non-legislative means.
Asked by: Lord Jackson of Peterborough (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government when they next expect to commission a foetal sentience evidence review and what organisations they will invite to undertake that and future reviews.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government does not formulate policy on foetal sentience. The review and determination of foetal sentience and its implications for abortion and clinical practice is reached through professional medical consensus and clinical guidance.
A recent and comprehensive review into Fetal Awareness Evidence was recently carried out by the Royal College of Obstetricians and Gynaecologists. Published in December 2022, the review concluded that evidence to date indicates the possibility of pain perception before 28 weeks of gestation is unlikely. A copy of the review is attached.
As an independent organisation responsible for producing clinical guidelines and setting standards for high quality women’s healthcare, the Government recognises their clinical expertise on this matter.