Health and Care Bill

Baroness Eaton Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I support this amendment, to which I have added my name. Evidence-based practice that utilises modern technology for the assessment and delivery of treatment for people who choose to take the first pill at home is cost-effective. I think we forget that the majority of healthcare workers, be they medics, midwives or nurses, try to provide person-centred care. Person-centred care means that some women will still be asked to come into the clinic to take that tablet because it is the best solution for that woman.

However, some women live in rural environments where there are very poor bus services. When I went to the women’s meeting at the UN three years ago with other Members of this House, young women representing the four country youth parliaments told harrowing tales of women who had been given the tablet in a clinic but had not got home before the spontaneous abortion commenced. We heard very good examples, particularly from some other countries in Europe, where taking the tablets at home was already normal practice.

The largest study on telemedical abortion in the world was conducted in the UK, covering 52,000 women both before and after the change—in other words, using the natural experiment that occurred as a result of lockdown. There was no change in adverse incidents, no change in successful completion rates, a reduction in waiting times, a reduction in gestation at treatment and it was preferred by women. This evidence was used by the US Food and Drug Administration to make the first tablet at home a permanent option at the end of last year. As the noble Baroness, Lady Sugg, has just said, the World Health Organization issued its international Abortion Care Guideline last week. Telemedicine and self-management of abortion outside a healthcare facility are both in there.

This amendment would enable better person-centred care for the majority of women, as well as for their families and often their partner who will be with them at the time—particularly for people who are perhaps having a third or fourth child which for clinical reasons is not advised. I therefore hope that the fact the majority of people here have a free vote means that they really consider what I have just said.

[Baroness Eaton (Con)]

My Lords, health and safety have arguably never been more front and centre in our nation’s thinking and approach to healthcare. The Government prioritising healthcare in one of their flagship Bills is therefore expected. I am proud of our Government.

As proud as I am, I feel equally perplexed as to why the amendment tabled by the noble Baroness, Lady Sugg, seeking to override the Government’s decision to end the temporary policy on at-home abortion would garner any serious consideration, given that it would contradict the aims of the Health and Care Bill by placing the health and safety of women and girls at risk. It also distracts from important matters in the Bill, for which the Bill was intended.

The provision allowing at-home abortion made alongside a host of other Covid regulations during an unprecedented global crisis was only ever meant to be temporary alongside almost all other temporary provisions of the Coronavirus Act that the Government are expiring or have already expired. The Prime Minister said that the Covid restrictions

“take a heavy toll on our economy, our society, our mental wellbeing and the life chances of our children”.—[Official Report, Commons, 21/2/22; col. 45.]


The health toll could not, in the specific case of the temporary provision allowing at-home abortion, be more apparent; it is a toll being taken on vulnerable women and girls. As highlighted by a submission to the government consultation on this matter, the lack of in-person consultation increases risks of potentially life-threatening conditions being missed, pills being prescribed beyond the 10-week limit, more women being coerced into a home abortion against their wishes and pills being obtained fraudulently.

These are not unwarranted concerns. Soon after the temporary policy was implemented, story after story emerged of the tragically painful experiences women underwent as a result of this policy. For example, a Telegraph article reported on a nurse whose at-home abortion led to extreme complications needing surgery. Indeed, there have been several cases of women taking these abortion pills outside the legal and safe time limit. For example, in May 2020 police investigated the death of an unborn baby after a woman took pills received by post at 28 weeks pregnant. Such cases are unsurprising given that abortion providers cannot ensure that at-home abortion pills are taken by the intended person in the intended circumstances and time. According to the American College of Obstetricians and Gynecologists, only half of women accurately recall their last menstrual period, again reaffirming that medical confirmation of gestational period is critical.

Given the vast evidence base highlighting how this policy has placed women’s health and safety at risk, an evidence base thoroughly reviewed by the Government in an extensive three-month consultation, I urge the noble Baroness, Lady Sugg, to withdraw her amendment but if she does not, I urge noble Lords to vote against it.

[Lord Alton of Liverpool (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Eaton, and I rather agree with the points that she has just made. But the noble Baroness, Lady Sugg, also knows that I have considerable admiration for her, especially over issues around the stand she took about cuts to our overseas aid programmes; we had the privilege of serving together on the Select Committee of your Lordships’ House that deals with international relations and defence. She will not be surprised to know that I find myself in disagreement with her and I urge your Lordships to think seriously about Amendment 183.

I will give the House two reasons for this, if I may. One is procedural and the other is more substantive. I suppose on the substantive point, I will cite, as the noble Baroness, Lady Eaton, has done, some of the contradictory evidence that we have before us. Your Lordships may not be able to work out whether you believe one side of the argument or the other, and that brings me straight to the point about procedure.

Here we are at almost midnight. This issue has never been debated at any stage in another place in the elected House. Rather like Amendment 170 that we discussed earlier, we have to consider how we resolve sensitive and controversial ethical issues of this kind. There was no consideration of this question in the elected House, and it has come to us without being considered in Committee but at the fag end of Report stage. Surely all of us can agree, wherever we come from on the more substantive point, that this is not the way to go about parliamentary business.

We should bear in mind that since 1967, when the original legislation was passed in another place and then approved here, there have been 10 million abortions, which is around 200,000 every single year. Put another way, there is one abortion every three minutes. You do not have to come from the position that I think noble Lords will be aware that I come from, of believing in the sanctity of every human life, to think that this cannot be right. Indeed, my good friend Lord Steel, who was the mover of the original legislation, has often said that he never intended abortion to be as widespread or repeated as often as it has become.

This all points to the question of procedure. Should there not be a joint committee of both Houses to consider this extraordinarily complex ethical question? Should we not at least have a Select Committee that considers these matters? Should there not be pre-legislative scrutiny before a Bill or an amendment of this kind comes before Parliament? It is passing strange that since 1967, no Select Committee of either House has looked at this legislation, the original Abortion Act 1967. I say to the noble Baroness, Lady Fox, who always makes valuable contributions to your Lordships’ House, that we are changing the law. That is why this amendment is before your Lordships’ House this evening. We would not need the amendment if we were not changing the law.

I also ask those who have rightly emphasised the importance of conscience, and particularly some of my friends and noble friends on the Lib Dem Benches, why this is not a conscience vote. Why is there a Whip on an issue of this kind?

Health and Care Bill

Baroness Eaton Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Eaton (Con)]

My Lords, I speak to Amendment 92B in my name. It seeks to reinstate essential, in-person safeguarding checks for girls under 18 when seeking abortion. I have no doubt that the noble Baroness, Lady Sugg, had the best of intentions when she brought her abortion-at-home amendment to your Lordships’ House in support of women’s right to choose in respect of pregnancy. Unfortunately, Amendment 92A leaves a glaring gap: that of the interests of young and vulnerable females. My Amendment 92B is simply about requiring a face-to-face consultation with a qualified health professional for girls under the age of 18.

This is an amendment purely about child safeguarding: specifically, minimising the risk of harm to children through the use of abortion pills. It is not an amendment about the moral question of abortion. There would be no change to where the pills are taken or administered. The amendment is supported by the NHS body made up of doctors and nurses who are the leading experts in the field of children safeguarding, the National Network of Designated Healthcare Professionals for children, or NNDHP.

The NNDHP, which supports safe access to abortion for young people, has released a statement saying:

“All children and young people—those under 18 and in care under 25—must be seen face to face, and the age of the other applicants must be confirmed. The purpose of this position is to clinically assess the mid-trimester risk and prevent coercion and exploitation.”


The network expressed particular concern that phone and video consultations

“enable unseen and unheard coercive adults to influence the patient”

and

“enable pills to be obtained under false pretences.”

These NHS child-safeguarding experts have also raised concerns about the effects of trauma and neglected birth, pointing to evidence of the home use of abortion pills resulting in highly traumatic incidents. These are traumatic episodes, and they point out that children do not have the emotional resources and the brain maturity needed to access support in these cases. Even worse, they are aware that the policy has led to the births of very premature but potentially viable infants.

The Royal College of Paediatrics and Child Health, the UK’s leading professional body for paediatricians, which represents more than 20,000 child health professionals in the UK and abroad, has backed the amendment. It has voiced its support for the amendment due to concerns about the risks to girls under the age of 18 with the at-home abortion amendment that passed in the Commons. The RCPCH has warned of a “glaring gap” in the legislation—namely, children and young people. Moreover, it has asked for children’s vulnerabilities to be taken into greater account as the Health and Care Bill reaches its final stages. The college points out that

“telemedicine can present particular challenges”

for children and young people, and points to the need to

“assess any safeguarding issues as part of the pathway for early medical abortions.”

I have mentioned the views of the NHS safeguarding experts and the royal college that specialises in children’s health, but I would like to end by touching on the story of a 16 year-old girl in his country that demonstrates the need for this amendment. The BBC reported on a girl called Savannah, who took abortion pills at home after a telephone conversation with an abortion provider. The clinic she had spoken to had calculated that she was less than eight weeks pregnant, but she was neither examined nor scanned. She took the pills and, when she felt terrible pain, she was taken to hospital. It was discovered that she was actually between 20 and 21 weeks’ pregnant, and she gave birth to a baby with a heartbeat. Indeed, she said, “My boyfriend said he could see feet”. Savannah said she had been left traumatised and said, “If they scanned me and I knew that I was that far gone, then I would have had him.”

It is hard to comprehend the trauma of an experience such as this for such a young woman. The BBC report highlighted how her case was just one of dozens. Surely, we in this House owe it to our young women and girls, our daughters and granddaughters, to do more to protect their safety and well-being. This is not an amendment nor a debate about abortion or a woman’s right to choose; it is about children’s welfare and enshrining in law the essential protections for girls under the age of 18. This Government, and, indeed, previous Governments, have rightly prioritised children’s welfare, and all of us in Parliament who make laws should keep this in mind.

I am pleased that my noble friend the Minister has understood the very real concerns of many noble Lords and professional bodies in the medical profession. He has expressed a clear commitment to us today to ensure that the concerns are raised and addressed. It is vital that regulations and guidance deal with the safeguarding of young women. My noble friend has committed to working with the Royal College of Paediatrics and Child Health and the NNDHP, and I hope that they will be consulted and will work with the Government to make sure that these extremely challenging and difficult conditions for young women are given great concern and protection in any further work on the Bill. Because my noble friend has given such reassurances, I will not push this to a vote this evening.

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Baroness, Lady Eaton, for raising this issue. I should declare that some years ago when I was a GP, I was responsible for looking after three care homes with children with really quite profound psychological disturbance because of what they had gone through prior to being taken into care. I carefully read the briefing from the Royal College of Paediatrics and Child Health. It is very important to listen to that college in particular, which has put out a remarkably strong briefing that also takes account of children up to the age of 25 when they are care leavers.

The last time we debated this I was concerned about contraceptive advice. I therefore contacted an abortion provider to ask about the contraceptive advice provided and was assured that really sound contraceptive advice is part of the telemedicine procedure. Does the Minister have any data on the number of second-time and third-time abortions that are being requested through telemedicine, as compared with those from face-to-face consultation? Certainly, in my time in practice, when one provided contraceptive services, one always felt that when somebody was presenting for an abortion, somewhere along the line one’s contraceptive advice had failed—often because of coercion by the male partner, one way or another. But for those who are emotionally vulnerable it can be very important.

I will address in just one sentence the excellent speech by my noble friend Lord Crisp in relation to his Motion J1. I hope the Government will listen to it, because we cannot carry on allowing the tobacco industry to exploit public health in the way that we have.