Complications from Abortions (Annual Report) Bill [HL]

Lord Moylan Excerpts

2nd reading
Friday 13th December 2024 Lords Chamber

Moved by

[Lord Moylan]

That the Bill be now read a second time.

[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.

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[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.

--- Later in debate ---

[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.

Bill read a second time and committed to a Committee of the Whole House.