Abortion Act

David Burrowes Excerpts

Wednesday 9th October 2013 Westminster Hall

[Mr David Burrowes (Enfield, Southgate) (Con)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I know that you share my concerns in this debate. I welcome everyone who is here for the debate and I thank the Ministers for coming. Their presence shows the seriousness and concern that are felt about the issue.

The debate has been triggered by The Daily Telegraph’s investigation into gender-selection abortion last year and the subsequent police investigation and decision by the Crown Prosecution Service on 5 September this year that it was not in the public interest to prosecute the doctors who were found to have contravened the Abortion Act 1967. The Director of Public Prosecutions has now given his detailed reasons, following a review of the public interest factors for or against prosecution.

Concerns about the authorisation of gender-selection abortion and the lack of any prosecution have been widely felt in the House and among the public. I am grateful for the support from hon. Members of all parties, despite our usual divide and the divide over the abortion issue. Indeed, 50 signed a letter to The Daily Telegraph. They were united in calling for clarity from the Attorney-General about the policy on contraventions of the Abortion Act. We look forward to that clarity coming from the Attorney-General today.

Keir Starmer, the DPP, recognised in his article on Monday that

“this country has a strong tradition of open and transparent criminal justice, and the probing and debating of prosecutorial decisions is an integral part to that tradition.”

Today I want to follow that fine tradition of probing and debating. The conclusion I have come to, supported by the DPP’s statement, is that the policy on prosecutions or offences contravening the Abortion Act is unclear, and, sadly, largely unenforceable. The DPP has helpfully shone a prosecutorial light on the practice of abortion where doctors have no direct contact with patients, where authorisation forms can be pre-signed, and where assessments concerning physical or mental health risk can be treated as routinely as questions of choice.

Some will argue that the issue of gender-selection abortion is simply a restriction of choice. Ann Furedi is the chief executive of the British Pregnancy Advisory Service, the leading provider of abortion services. It has some 40 clinics in England, Wales and Scotland and performs 60,000 abortions a year. She says that sex selection may not be grounds for abortion, but there is no legal requirement to deny a woman an abortion if she has a sex preference, provided that the legal grounds are still met. Indeed, Ann Furedi went so far as to say it would be “wrong” to refuse to consider an abortion request when gender is cited as a reason. Those are the words not of the Chinese or Indian pregnancy advisory service but of the British Pregnancy Advisory Service, advocating gender selection abortions and the removal of barriers to abortion. The issue is worldwide: The Economist recently published an article describing the 100 million abortions, which it described as “gendercide”, that are done on the basis of gender throughout the world. Concern is shared throughout the House about the need for proper gender equality and respect for basic rights.

When I heard about the investigation and the Care Quality Commission investigations that followed, I could not believe that such things could be happening in this country. The words I have quoted and the lack of any prosecutorial decision—there have been a handful of prosecutions for abortion contraventions in the past 10 years—give a green light to abortion on demand, which flies in the face of the Abortion Act and the intention of parliamentarians in 1967. Some 98% of abortions tick the box of mental health risk, but if we are honest, the truth is that that covers a multitude of reasons, and one of those reasons might include gender.

The DPP himself has referred in his statement to a programme manager at the Department of Health who indicated that many doctors feel that forcing a woman to proceed with an unwanted pregnancy would cause considerable stress and anxiety. The corollary of that is justifying the mental health grounds. It follows, therefore, that in practical terms we have in this country abortion on demand. I recognise that the Attorney-General is focused on the prosecution policy and will not trespass into the wider health policies, but my question is relevant. How does this reality impact on the policy towards prosecutions? How can it be in the public interest—Ann Furedi has raised this question—to prosecute contraventions of the Abortion Act when there is such a gap between the law and practice?

[John Glen (Salisbury) (Con)]

The key issue is about the definition of the mental health issues and the bar that is set for them to be understood to be a meaningful reason for an abortion. That can be a catch-all for an inclination on any grounds to have an abortion. If it is not set clearly and applied appropriately, it will result in what my hon. Friend has set out.

[Mr Burrowes]

My hon. Friend makes a good point. A wider issue is transparency and honesty around definitions and assessments. It is an issue because 99.6% of the 98% who relied on the grounds of mental health risk are those that this applies to. The investigation and the reasoning have highlighted the lack of guidance and how it is disparate across the country. We need further information. We are in the unknowns, because there is a lack of data and proper information. We do not know enough about the assessments in relation to mental health grounds. Perhaps the doctor is not even present to make the assessment.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am grateful to the hon. Gentleman—I shall call him my hon. Friend this afternoon—for securing this debate. Following on from the previous intervention—I think he is starting to allude to it—if the doctors concerned are not even meeting the woman who is presenting and requiring an abortion, how are they to judge whether the barrier is met?

[Mr Burrowes]

My hon. Friend—he is very much my hon. Friend in these matters—is right. In the case that brought about the investigation, both GPs failed to carry out an in-depth mental or physical assessment of the patient. One GP even claimed that he thought the patient was lying. Instead of taking it a stage further and delving further, they agreed to authorise the abortion. In one of the cases that have been reported, one of the GPs brazenly said that it was “like female infanticide”.

We need to get to the bottom of what the law is for, and that is the focus of this debate. We will then draw attention to the issue of appropriate guidance. So what is the law on gender selection abortion? My hon. Friend the Member for Broxtowe (Anna Soubry), the outgoing public health Minister—I welcome the new Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who is here—wrote to me on 3 October; it was one of her last letters as public health Minister. She wrote to say unequivocally, and it has been repeated by the Secretary of State for Health, that abortion on the grounds of gender alone is unacceptable and illegal. This has not changed. I therefore look forward to the Attorney-General making the obvious point and confirming the policy position. However, there is some doubt, because Ann Furedi, the BPAS chief executive, says that the law is “silent” on the question. Indeed, the DPP in his letter on 7 October said quite properly that the law does not expressly prohibit gender-specific abortions. Rather, it prohibits any abortion carried out without two medical practitioners having formed a view in good faith that the health risks of continuing with the pregnancy outweigh those of termination.

The public might be surprised that such a prohibition is not expressed and that it is not clear. The British Medical Association takes it a stage further, aside from the issue of whether there is an express prohibition. In the BMA’s words,

“there may be circumstances, in which termination of pregnancy on grounds of fetal sex would be lawful”.

That is in the BMA’s handbook of ethics and law and the guidance that goes to GPs. The concern about policy—this is my question to the Attorney-General—is whether the law is clear or silent. In particular, we are concerned about the practice emanating from the policy, which in effect is to turn a blind eye to contraventions of the Abortion Act.

[Robert Flello]

I am listening carefully to a well-measured and thoughtful speech. Perhaps Members will forgive my simplicity in such things, but is it not the starting point for any position that any termination of an unborn child is infanticide, and that the 1967 Act gives specific situations in which it is not? Therefore, surely the default position must be the original position, as it was before the 1967 Act.

[Mr Burrowes]

That is the position in principle: the Abortion Act provides effective safeguard and defence against the Offences Against the Person Act 1861. We have a gap, therefore, and the issue is, where it has been exposed—rarely do such cases see the light of day—why, when the evidential threshold has been reached, is it not considered in the public interest to take things a stage further, into court?

In the particular cases brought to light by The Daily Telegraph investigation, the DPP and the CPS give much weight to the law giving

“a wide discretion to doctors to determine when a risk to the health and wellbeing of a pregnant woman exists”.

The CPS stated that it was up to doctors “to interpret the law” and, flowing from that, that the cases were

“better dealt with by the GMC rather than by prosecution.”

The gap I referred to is, therefore, in effect being determined by doctors, with their wide discretion to interpret the law—if a problem is exposed, it is for the professional body to investigate. As a politician, to me that seems to be passing the buck—the responsibility for enforcing the law—from the courts to doctors, thereby second-guessing the intentions of Parliament on enforcement.

As a criminal defence lawyer, I looked more deeply into that decision. The reasoning seems to be for an evidential rather than a public interest factor against prosecution—the public interest factor was the focus of the review. The CPS statement seemed to be going into what the DPP himself admits were the overlapping considerations of the evidential and public interest tests. The main basis of the DPP’s reasoning for not supporting a prosecution—which went a stage further and, with great respect, I suggest perhaps moved the goalposts towards the evidential side of things—was the evidential difficulties arising in the case, which I think can be applied generally and are of general concern in all such cases. Although the evidential test in that particular case had been passed, my concern is that the wider public interest appears to have been sidelined. That is not only my view, although I have 20 or so years of experience in the criminal law and in dealing with cases where it is difficult to detect a crime.

What is the public interest factor in such cases? The former DPP, Lord Macdonald, drew attention to that point, saying that there is “strong public interest” in prosecuting crimes that are hard to detect, such as sex-selection abortion. The onus is therefore much more on looking into what is in the public interest when so few cases are exposed and where we recognise that there are evidential difficulties—perhaps inherent—in the current system, given the lack of guidance. Does that not make the case even more strongly for a prosecution being in the public interest?

[Glyn Davies (Montgomeryshire) (Con)]

I thank my hon. Friend for bringing a subject of such huge interest and importance before us. What impact does it have on public perception of the law and its integrity? Any effect can spread to all sorts of other areas, such as assisted suicide. Once the public’s perception is that the law is not enforced, as it has been in one or two cases, confidence in the law’s ability to deal with highly complex issues disappears.

[Mr Burrowes]

My hon. Friend makes a good point. In cases of assisted suicide, the DPP has come forward with guidance to provide some clarity, and that was carefully worked through. One of my requests to the Attorney-General is to reflect on what has happened and, with the DPP, to come forward with clear guidance to ensure that confidence in the integrity of the law that many say has been lost. I also ask the Attorney-General to comment on the former DPP’s view. In addition, it must be in the public interest, in policy terms, for such cases, in which there has been an obvious abuse of abortion legislation—the cases are unusual and rarely see the light of day, because they are not readily detected—and in which the evidential threshold has been passed, to be seen in court.

The danger now is that the decision by the DPP, following on from the CPS, sets a precedent—no prosecutions under the Abortion Act without clearer evidence. Where will we get that clearer evidence? Do we now have a new evidential test for abortion-related offences, which can rarely be satisfied due to the lack of the different factors affecting this, not least the lack of professional guidance from doctors?

Another concern about the CPS decision not to find public interest to prosecute was the deferral to the GMC to enforce the breach of law. That was particularly apparent in the original decision of the CPS, which saw that as a key factor. The last time that I checked on enforcement of the Abortion Act, it was for the courts to do, and not for a disciplinary committee of GPs, which was never mentioned or even suggested in 1967. That option is certainly not in statute. This is specifically prescribed in statute as a contravention, and the law should be enforced. I trust that the Attorney-General will make it clear today that criminal sanctions cannot be avoided because of professional status—making a point about integrity—and that applies across the board with other instances of criminality involving the professions. Plainly, everyone is equal under the law, although some of us would say that that is not the case for an unborn child.

The CPS decision to drop the case and to leave it to the GMC highlights the gap between abortion law and practice. That must be filled somehow, at least by guidance through GPs, but also by reform of the legislation. I therefore welcome the assurance that I received from my hon. Friend the Member for Broxtowe, then an Under-Secretary of State for Health, that the Department of Health has requested that the chief medical officer issue guidance. I look forward to it, and hope that there will be proper consultation on it.

Such guidance is needed not only because of the cases involving GPs highlighted by The Daily Telegraph, but also because of the CQC investigation in July last year. Fourteen NHS hospitals throughout England failed inspections, all involving the photocopying of doctor’s signatures and other breaches. For example, Rochdale hospital’s regular routine was to pre-sign all abortion forms—not only in one case—and the Princess Alexandra hospital in Harlow used the photocopied signature of a doctor for so long that it was well beyond the time that he had been employed as a doctor or could have had any knowledge of the cases. Such is the extent of the abuse and breaches of the Abortion Act. Such malpractice would not be tolerated by patients or others in the prescription of antibiotics or common painkillers, for example, and yet a blind eye is being turned in abortion cases.

The scandal is not only about malpractice, however; those hospitals were not referred to the police for investigation, and no CQC investigation has resulted in any prosecution to date. Why is that? What is going on? Will the Attorney-General respond about the policy? The system is open to abuse, to dishonesty and to criminality, which, without reform, are going unchecked and unprosecuted.

Why was the DPP not more involved at an earlier stage in the initial CPS decision on whether to prosecute, given the significant public interest? Was the Attorney-General consulted on that decision, given the public policy considerations, and if not, why not? Will guidance be provided to the CPS for consideration of future contraventions of the Abortion Act? Will a review consider whether the safeguards set down by Parliament, in good faith, are being properly applied in 2013 and still have full force in law?

On the subject of public interest, which is what we are discussing today, I want to thank The Daily Telegraph, which has been acting in the public interest by investigating and exposing the problems with the Abortion Act, which are of concern to many, on all sides of the fence on the issue of abortion, in particular because such problems might have led to sex-selection abortion. Without such investigative reporting on behalf of the public interest, there would probably be no one to complain, and the issue would go by the bye. The reality is that the unborn child has no complaint process. There is a lack of transparent information, and no real safeguards. It is up to Parliament to deal with that, and we must seize on it in this debate and beyond by speaking up for the voiceless, ensuring that we respect life and at least to ensure that the Abortion Act contains safeguards with proper meaning and proper force.

[Mark Pritchard (in the Chair)]

Five hon. Members have indicated that they wish to speak, and I do not want to impose a time limit so I hope that colleagues will be mindful of others, given that I want the wind-ups to start at 3.40.

--- Later in debate ---

[The Attorney-General (Mr Dominic Grieve)]

It is a great pleasure to serve under your chairmanship, Mr Pritchard. I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate.

Investigative journalism plays an important part in a vigorous and healthy democracy. The Daily Telegraph has done a very important public service in bringing these issues before us today. The debate has been a characteristically thoughtful one, as befits matters touching on the criminal law, personal health and dignity, ethics and moral issues, professional standards and the wider public interest. I am grateful to the hon. Member for Strangford (Jim Shannon), my hon. Friends the Members for Gainsborough (Sir Edward Leigh), for Totnes (Dr Wollaston), for Congleton (Fiona Bruce) and for Tiverton and Honiton (Neil Parish) and the hon. Member for Islington South and Finsbury (Emily Thornberry), who have all made contributions, and to those right hon. and hon. Members who have intervened.

The cases highlighted by The Daily Telegraph were much debated at the time of the original CPS decision not to prosecute. The terms of that debate may have given the public the impression that this case was about medical practitioners offering abortion on the basis of the gender of the child. On that basis, it may well have seemed incomprehensible that the full force of the criminal law was not being brought to bear on a practice that most people would regard as abhorrent. I certainly do and I think that everyone in this room does. But as I hope to make clear and as I hope has been made clear by the DPP’s explanation, that is not in fact what these cases are at root about.

The DPP has recently published detailed reasons for the CPS decision. I urge all right hon. and hon. Members to read his account very carefully, if they have not already done so. It is absolutely right that prosecution decisions are taken by independent prosecutors on the facts before them and free from political influence. That is what entitles the public to have confidence in those decisions. However, it is also important that the public should be able to understand the decisions and, where that is not straightforward, that prosecutors make a special effort to explain them. This was obviously such a case, and I am particularly pleased that the director has taken the time and trouble to review—I requested him to do so—the decisions personally and to set out fully the reasoning that led him to endorse the conclusion that it would not be right to prosecute.

[Mr Burrowes]

Will the Attorney-General give way?

[The Attorney-General]

In a moment; I was going to answer the two questions raised by my hon. Friend. First, the director did not make the initial decision not to prosecute, but he was consulted, as is normal in complex and sensitive cases. The answer to the second question, on whether I was consulted on the decision before it was taken, is that I was not. The case was not raised with me by the director prior to the decision not to prosecute being taken. In my view, it should have been, and on reflection, the director accepts that he should have done so. Before that leads to an inference that therefore the decision might have been different, I simply make the point that as I asked the director to review the decision completely and I had ample opportunity to consult with him before he did so, I am satisfied that the decision that has now been reached, which I will come on to in a moment, would have been the same had that process taken place in the first case.

[Mr Burrowes]

Does my right hon. and learned Friend the Attorney-General agree that in hindsight it would have been appropriate for the DPP to be involved at an earlier stage, to respond to the question raised by the shadow Attorney-General, and should not all future investigations of allegations of contraventions of the 1967 Act involve the DPP at that earlier stage and proper consultation with my right hon. and learned Friend?

[The Attorney-General]

As my hon. Friend will appreciate, the DPP himself does not under the statute have to give consent. Nevertheless, I am sure that the DPP will have noted my hon. Friend’s comments—representatives of the Crown Prosecution Service are here. It is clear to me that this is an important issue in a difficult area, which I will come on to in a moment. I trust that his comments are noted, but he will appreciate that the decisions are ultimately for the DPP, not me.

The director’s reasons speak for themselves. I am satisfied that this difficult decision was taken properly and conscientiously. The responsibility of taking such decisions is a heavy burden, which few of us would relish. I would like to take the opportunity to pay tribute to the distinction with which the current director has fulfilled an onerous and difficult series of public duties over recent years, particularly as his term of office is drawing to a close.

The hon. Member for Strangford asked whether I agreed with the decision taken by the director. I emphasise the point I made: I am clear that it is not my role as Attorney-General to second-guess the decisions of independent prosecutors. These were difficult decisions on which different prosecutors could reasonably have come to different conclusions, but I am entirely satisfied that this difficult decision was taken properly and conscientiously.

I shall say a little more by way of context. First, abortion law in this country, in my judgment, is workable, but needs to be understood. I should perhaps emphasise that the law is not framed in terms of prohibiting gender-specific abortion or indeed listing any other forms of unlawful abortion. It works, or was intended to work by Parliament, by providing for abortions to be performed safely, by qualified medical practitioners, when those practitioners judge it to be in the medical interests of the patient and where that is the course that the patient herself agrees is right. Two medical practitioners must on each occasion have formed a view, in good faith, that the health risks of continuing with a pregnancy outweigh those of termination. That is our guarantee, as provided by Parliament, that we have a system of safe and lawful abortion provided by the 1967 Act.

--- Later in debate ---

[The Attorney-General]

I reassure my right hon. Friend that that is certainly not the case. Ultimately, in any case, the jury decides, not the experts. One would normally expect a jury to be given some indication of the professional standards expected in a profession—there may even be rival professional views about what the standards should be—in order to help it decide.

Such a problem might not arise in an extremely clear-cut case. We might imagine a case in which a doctor behaved in a way in which no reasonable practitioner would behave, for example by arranging a medical abortion for a patient about whom he or she knew nothing and whom he or she had never met or spoken to. In any other circumstances, however, the CPS would need, and would expect to be able, to refer to medical consensus to determine whether a proper professional approach had been taken.

When they are looked at in the kind of detail considered by the prosecutor, the cases that we are debating are not extreme ones in which the doctors behaved as no reasonable practitioner would behave. Complicating factors were raised by both the patients and the doctors, who subsequently had to take the decisions. There were, as we have discussed, no detailed professional rules or step-by-step guidelines telling doctors how to take such decisions; the matter was left to general professional standards and ethics. The CPS, therefore, had no detailed consensus to help it to evaluate the matter.

To prosecute would have been to ask a jury to decide what steps a doctor should take. Juries take difficult decisions robustly, and sometimes they have to find their way through conflicting medical evidence. Is it right or fair, however, to ask a jury to arbitrate on a question of medical standards and ethics on which the profession has not published a detailed consensus, and on which a great deal turns for both doctor and patient? The CPS concluded in the recent cases that it would be contrary to the public interest to proceed.

Those who have the relevant policy and professional responsibilities are, no doubt, reflecting on the conclusions to be drawn. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is present for precisely that reason. As the House will appreciate, these are not my responsibilities.

[Mr Burrowes]

I recognise that in such cases, because of the level of uncertainty, it is questionable whether a prosecution would serve the interests of justice. When more certainty has been achieved through the publication of guidance, will the Attorney-General undertake to review the matter and consider whether further guidance is required to provide clarity on prosecution?

My supplementary question is to ensure that the Attorney-General does not get off the hook without commenting on another issue. The CQC has provided evidence of 14 hospitals where—forget “good faith”—doctors were not even present when forms were signed. Surely the Attorney-General must ask why no prosecutions occurred in such cases, which go way beyond questions of guidance. They are malpractice and a flagrant abuse of the Abortion Act 1967, and they must lead to prosecutions.

[The Attorney-General]

I hope I may be able to reassure my hon. Friend. On the second matter that he raises—it is not germane to one of the cases, although it was to another—as he knows, the evidence revealed that the pre-signing of forms was quite widespread. I understand that that practice has now been stopped, and that clear guidance has been issued as to its undesirability. That is a policy issue, and I have no doubt at all that as a result, the requirements set down by professional standards have already been clarified.

I turn to the more general point. There are two ways in which we can move forward. We might take the view that the current situation is, overall, a satisfactory one, in which professional medical discretion, which must inevitably be relied on, is left at large, with the law enforcement agencies acting as a back-stop for the most egregious cases that flout any conceivable proper standards. The other view, which I understand that the Department of Health has accepted, is that such a situation allows law enforcement far too residual a role and that the balance needs to be redressed. The law enforcement agencies will need clearer and more specific guidance on how to distinguish between desirable and undesirable professional practice in making and recording decisions on the termination of pregnancy. I greatly welcome that, and I have no doubt that it will make the task of prosecutors much easier.