Lord Moylan

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That the Bill be now read a second time.

Lord Moylan (Con)

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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.

Baroness Barker (LD)

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My Lords, I am going to take the opportunity to explain the context of the Bill and say what it is really about. In doing so, I thank the noble Lord, Lord Moylan, for yet again giving me the opportunity to draw your Lordships’ attention to the right-wing, nationalist, countergender campaign which this Bill and his previous foetal sentience Bill are a part of. We have known for some time that there is an international campaign which has an overriding strategic objective of getting rid of human rights legislation and the organisations responsible for upholding it.

On a tactical level, it has a number of objectives: anti-LGBT campaigning—with a particular emphasis in this country on anti-trans work; anti-sex and relationships education, because the state should have no part in teaching people’s children about sex and relationships; anti-surrogacy, and particularly anti-abortion. People may have read or seen, most notably, the campaigns in places such as Hungary and Poland. It is all about a campaign to restore the natural order—a selective reading and interpretation of biblical order.

When I have said that in this Chamber before, Members of your Lordships’ House have thrown the jibe, “Well, that sounds like a conspiracy theory”. Well, it is not actually, and we have some growing evidence to that effect. I encourage all noble Lords to read Project 2025—it is a very easy and clear read. It says what the organisations behind it, such as the Heritage Foundation, the Alliance Defending Freedom and big supporters of the Conservative Party in this country have as their agenda for the Trump Administration. It is all backed up by billions of dollars going to Africa and billions of dollars coming to Europe including to the UK. It is a campaign which has evolved, just as the anti-abortion campaign has evolved from rather crude demonstrations outside abortion clinics; it has now gone into a slightly different phase. It is now setting up independent universities and colleges; it is producing research evidence; it talks using the language of rights, but all the conclusions go back to that same overall objective. It is very clever, very well organised and brilliantly messaged, but it is what it is: it is a very cynical anti-gender campaign about destroying human rights.

This Bill is an insidious part of that campaign. It is about challenging the medical evidence that does not suit its campaign objectives. I, like other people on my side of the argument, am all in favour of collection and improvement of data. What I am not in favour of is the corruption of medical science by the production of data for a purpose. That, I suggest, is the ultimate aim of the Bill in the name of the noble Lord, Lord Moylan. Therefore, I hope that noble Lords will not be taken in by this, will see it for what it is and work with people such as those at the Royal College of Obstetricians and Gynaecologists who want to improve the data and to make sure that our services are safe for women.

Baroness Foster of Aghadrumsee (Non-Afl)

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My Lords, I commend the noble Lord’s Bill to the House. It offers a moderate proposal that ought not to be controversial. Whatever one’s view on the issue of abortion, it is clearly in the interests of public health and patient safety to ensure that accurate data is collated and reported concerning the scale and nature of complications from abortions, as with any medical procedure. As the noble Lord has explained, current reporting is deficient and has not caught up with the changes concerning how an increasing number of abortions now occur.

As well as supporting the comments that the noble Lord has made, I wish to make two further points in relation to the Bill in the short time available to me. First, I note that while the 2023 Department of Health publication on which the Bill is based records data more accurately than previous reporting, it acknowledges in its own annexe that it does not include complications under the code O044. That code records “incomplete” abortions, where part of the unborn baby remains inside the mother after an abortion.

That report includes hospital episode statistics relating to incomplete abortions where they have led to additional complications but not to incomplete abortions themselves. However, given that any incomplete abortion routinely requires further treatment to remove the remaining parts of the baby to avoid the risk of infection, it seems to me that those also ought to be included in any accurate recording of statistics.

The second point I want to make is in relation to Northern Ireland, as all noble Lords would expect. While I understand that the Bill relates to England in order to correspond to the November 2023 report, I would like to see an improvement in data collection and reporting in Northern Ireland. Since abortion was decriminalised in Northern Ireland, reporting on abortions has been woefully inadequate. Indeed, we appear to have even less data concerning complications than the limited data published in England.

The regulations attached to the Northern Ireland abortion law require abortion providers to report

“Particulars of any complications experienced by the woman up to the date of discharge”.

That means we have the same problem as in the rest of the UK, because complications which arise after discharge, and which come to light in a hospital setting only when a woman seeks further treatment, are unlikely to be recorded in official statistics. It would be really good if we had better information and data in Northern Ireland, as here in the rest of the UK.

Data informs health trends; it gives transparency and understanding, but, above all, it ensures patient safety. The purpose of this Bill is to have accurate data, and I am very happy to support it.

Lord Frost (Con)

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My Lords, it is a pleasure to follow the noble Baroness, Lady Foster, who spoke, as she always does, powerfully, compellingly and rationally—it is important keep that rational focus on this important Bill. I thank my noble friend Lord Moylan, who set out the rationale for it clearly, compellingly and in some detail, and I am delighted to have this opportunity to support it.

Whatever one’s views on the substantive question of abortion, I find it hard to see why we would not want as much information as we could possibly get on this question, especially when, as my noble friend Lord Moylan noted, there is clear evidence for at least a potential anomaly that needs addressing in the statistics. It is surely in the interests of any woman considering an abortion to have the best possible information about the possible risks involved.

In the short time available, I want to make one further point to those that have been made already, on the objection from the British Pregnancy Advisory Service—which the noble Lord, Lord Moylan, has already noted—that this Bill would in some way “exceptionalise” abortion. I find that worthy of a brief comment. As the noble Lord said, abortion is already exceptional in various ways. One might note in passing that it is the only form of healthcare that has required the suspension of free speech rights—and even non-speech rights, those of free thought—to allow it to be transacted. Passing on from that, more substantively, it is exceptional because it is one of those areas of care where there really are starkly clashing worldviews. I am sure that we will hear much more about that later on this morning. That means that it always is going to be subject to debate, unless there is some fundamental change in the ethical basis of our society. Therefore, ways through have to be found, in a free society, to accommodate that.

The need for debate around abortion provision will, and I think should, always make it exceptional. It means that we need that debate to be as well-founded as we can possibly make it—well-founded in the moral judgments that we bring to it and well-founded in having the best possible information and analysis around it at a technical level. That is what this Bill would help to provide, and that is why I support it.

Baroness Bennett of Manor Castle (GP)

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My Lords, in following the noble Lord, Lord Frost, I stress how important the Green Party and many other people regard protecting those receiving healthcare from harassment and abuse. That is something that the law has increasingly stepped up to do, and it is terribly important.

I oppose this Bill. I begin by commending the speech of the noble Baroness, Lady Barker, who gave us an important sense of context here. This is about a very long-term, global, but US-based, exceptionally well-funded campaign against human rights. Back in 2014, I wrote a chapter in a book entitled Women Against Fundamentalism: Stories of Dissent and Solidarity, which told the story of what happened in the 10 years leading up to where we are today.

I will focus a little on context. It is important to note that, last year, YouGov looked at attitudes towards abortion and found that 87% of Britons said that abortion should be allowed, while only 6% said that it should not. It is interesting to note that one in 10 Britons think that the law makes it too difficult to get an abortion in the UK. When you look at those for whom this is most relevant—women under the age of 40—you find that that figure rises to 19%. Those are the people who are most likely to encounter the detail of the law and to have discovered, as many are surprised to, that abortion is covered by criminal law still in the UK. It is important to highlight that.

As we talk about abortion, one issue is the rise we have seen in the investigation and prosecution of what is suggested might be illegal abortions. In the 18 months to February, there was a risk of convicting as many women as have been convicted for that offence in the previous 55 years. Six women were prosecuted over suspected abortion cases, although three of those cases were subsequently dropped—the women having been through very considerable turmoil in the meantime. The president of the Royal College of Obstetricians and Gynaecologists has noted how outdated abortion law really is creating problems. That is the context.

We have already covered quite a bit of ground here. It is obvious that creating a law about one set of medical statistics is exceptionalising it, as BPAS says. In 2023, three years of work went into a report then that said that the statistics were inadequate and needed to be improved. The work is being done; we do not need to pass a special law on one set of statistics. We are making progress on this, and more progress is certainly needed.

Baroness Lawlor (Con)

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My Lords, I speak in favour of my noble friend’s Bill. I am a great supporter of patient empowerment, and one sure way to give patients power is to arm them with knowledge and the medical options available to them. Recently, I had a hand procedure for Dupuytren’s disease. In the run-up to the procedure I wanted to know all the evidence available about the condition itself, the treatment, the options, the aftercare, and indeed the complications. I did so partly by talking to a GP and other doctors I knew, but partly by looking at websites.

This simple measure, proposed by my noble friend Lord Moylan, for a report that collates both sorts of data—that from the hospital episodes statistics and that from the ANS—will provide a fuller picture for people like myself. More importantly, it will strengthen the channels of information on the complications arising from abortion. While the annual published statistics may not be read by many people, and rely solely on the ANS data, note will be taken of a report issued by the NHS that collates the full information, both from the medical press and GPs. Levels of public information about possible complications and potential risks will be available. Because the role of medical practitioners in advising about any procedure is rightly deemed central, it is important that, as a result of the measures proposed in this Bill, they will be better informed.

My mother was a doctor. My abiding recollection of her is that, every night, at the end of the day when her chores were done, she would pick up her medical journals and updates on all medication available to keep herself up to date with the latest evidence and research, in an otherwise very busy day. That was what she anticipated doing each night, and she was bang up to date on treatments and everything to do with her work.

Not only that, but an annual report could be read by people themselves, especially if they want to follow up on one or other point of the medical advice. Professionals can disagree among themselves about how they interpret the evidence—we heard from my noble friend Lord Moylan one example of how gynaecologists can disagree over even a definition. It would be very helpful for people to see such a report for themselves; this is particularly so in the case of sensitive subjects.

For all those reasons, I support requiring an annual report on the complications such as that proposed in the Bill, which is along the lines of the 2023 report by the NHS. I wholeheartedly support my noble friend’s Bill.

Baroness Miller of Chilthorne Domer (LD)

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My Lords, this is not my area of expertise. Like the noble Lord, Lord Moylan, my background is in local government and business. Unlike the noble Lord, Lord Moylan, I do not think that we should be passing legislation on which areas of health we should collect data on. Certainly, we should collect the data, and certainly our job in this House is to question inconsistencies, but it is not to legislate for them.

The noble Lord, Lord Moylan, criticised the British Pregnancy Advisory Service for talking about “exceptionalism”. In fact, at the heart of this Bill there is an illogicality. It tries to collect data just on the abortions and is not looking at the complications—for example, of women having to carry to term babies that, for a multitude of reasons, they would have chosen to abort.

On the face of it, this is a very logical Bill, but I am grateful to my noble friend Lady Barker and the noble Baroness, Lady Bennett, for laying out the context and background. When I looked at the last Bill from the noble Lord, Lord Moylan, on sentience, I got a clue as to where he is going with this whole thing. That is why I have chosen to speak briefly today.

I deeply believe in a woman’s right to choose what she does with her body. Women’s rights, as the noble Baroness, Lady Hodgson, said when she was talking about her Bill on peace, are being rolled back across the world and it is our job to make sure that we uphold them. It has taken centuries to get to a place where back-street abortions are a thing of the past in this country, and I do not wish to see us make any move that makes us arrive at a place of less safety. It took so much effort to get women to a place of greater safety and we must stop any attempt to reverse that.

Baroness Sugg (Con)

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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)

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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.

Baroness Sugg (Con)

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My Lords, as I say, I am very much in favour of ensuring that information is fully available, but I am concerned about having primary legislation singling out one medical procedure. It could promote fear and concern around women and make them feel as though they are not able to make their own choices around healthcare. It should be regulated like any other medical procedure. By treating it differently, we could add stigma. It is important to consider this in the wider context of the current politicisation of the abortion debate around the world.

We have heard about the difficulties of collating and collecting this data. Collating the current available data does not give an accurate picture. These issues were highlighted in the 2023 report. I would be interested to hear from the Minister about the department’s experience of collating the report: whether she thinks it is the best use of resources and indeed whether it led to any practical action that has improved healthcare.

The current reporting systems are far from perfect. We also have to be careful about when we link records, because that is not always desirable. Many women, especially those facing domestic violence or reproductive coercion, may not want their procedure recorded. Confidentiality is crucial for safety. A lack of privacy could deter women from seeking care, putting them at greater risk. For that reason, I cannot support the Bill as it stands.

I agree that improving data collection within women’s healthcare is essential, but that can be achieved in ways that respect privacy while improving care. The NHS 10-year plan and the women’s health strategy update offer a good opportunity to address these challenges effectively, without adding unnecessary legal burdens on the healthcare system. As we look to enhance women’s healthcare, we must proceed carefully and sensitively, balancing data collection with privacy and choice for women.

Lord Scriven (LD)

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My Lords, I thank the noble Lord, Lord Moylan, for this Bill. He may not realise that he has highlighted an important issue that needs to be addressed—not the limited and, I may say, misguided focus of this Bill, but the wider issue of robustness of health datasets and the reliability of statistics used to plan, improve and deliver safe services as part of our healthcare system. As a former health services manager, I have taken an interest in this for a long time.

The NHS is one of the most data-rich healthcare systems in the world, yet some of its datasets suffer from weaknesses that can impede its ability to deliver high-quality, data-driven care. These weaknesses can broadly be categorised into areas of data quality, interoperability, accessibility and governance. One of the fundamental challenges lies in the inconsistency and incompleteness of data. NHS datasets often include outdated, duplicated or incorrect information due to variations in how data is recorded across trusts and practices. For example, patient demographics, diagnosis or treatment codes and records might be inconsistently documented, making it difficult to draw accurate insights. This runs into thousands of conditions and treatments, not just this one, which I hazard an educated guess has not been randomly plucked for the attention of this Bill. When you add in the private sector, it becomes near impossible to provide a complete patient journey through statistics to help improve patient care.

If the noble Lord, Lord Moylan, and his supporters want to improve healthcare outcomes for not just women but everyone, and safety and policy built on better data, their Bill should focus on legislating to improve data quality in the NHS. It should be about adopting national standards for data quality, promoting interoperability, enhancing accessibility, strengthening governance and transparency and leveraging advanced analytics. So why pick out just one treatment among thousands with poor and conflicting data in our healthcare system and make the exception of trying to report it to this Parliament? The noble Lord’s reason for exceptionability does not stand up: 55% of ophthalmology cases are provided by the private sector and 30,000 hip replacements are provided by the healthcare sector.

This Bill is a back-door attempt to limit abortion in this country, using statistical jiggery-pokery as a smokescreen. I say sorry to the noble Lord and his supporters, but this just will not wash. The real motives need to be exposed. It is telling that the majority of those actively campaigning for this Bill are the very organisations that are prominent in attempts to restrict or, in some cases, ban abortion in this country.

These Benches will support genuine and effective measures to improve datasets in our healthcare system, to improve safety and outcomes for not just women but all patients, but we will not support the ideas of this Bill, which are not a foundation for effective improvement in healthcare and healthcare safety. We need to be clear: this Bill will not deal with the underlying weaknesses of healthcare datasets. It is the first step in an agenda to restrict women’s choice and, in some cases, restrict abortion altogether.

Lord Sandhurst (Con)

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My Lords, this Bill performs an important service. It highlights the absence of accurate, comprehensive statistics in respect of abortions. My noble friend Lord Moylan is to be congratulated on his clear exposition of the complex issues involved. I am also grateful to the Library and the Royal College of Obstetricians and Gynaecologists for their briefings.

The Department of Health has highlighted that the statistics on complications from abortion should be treated with caution, particularly following changes to the way that medical abortions are permitted to be carried out. It has explained that it is not possible fully to verify complications recorded on the relevant HSA4 forms. Complications that occur after discharge may not always be recorded.

My noble friends Lord Frost and Lady Lawlor have highlighted the importance of good data. In April 2021, the Government acknowledged limitations with the data provided on the HSA4 forms. The Office for Health Improvement and Disparities then undertook a project to review the system of recording abortion data to address the limitations of the data on complications recorded on the HSA4 forms.

OHID acknowledged limitations with data collected through the HSA4 form on the abortion notification system, otherwise known as ANS. Abortion complications are recorded differently in hospital episode statistics—HES—compared to the ANS. Each data source has different strengths and limitations, according to the experts. Neither data set would, however, include complications diagnosed by a GP, the 111 service or an A&E department. The OHID publication did not make any recommendation as to whether HES data should be used to supplement ANS data in the future, and they are the experts.

The royal college argues that lack of effective data collection has held women’s reproductive healthcare back in its ability to innovate and improve, and that that is to the detriment of patient care and experience. The royal college submits that data collection must be improved within women’s healthcare and that abortion should be treated and regulated like any other medical procedure. None the less, as it points out—and as I understand—in no other area of healthcare, outside of abortion, does primary legislation impose a duty on the Secretary of State to produce an annual report of complications data.

We on this side of the House fully recognise the power and benefits of transparency of data to the public and within the Government, and my noble friend has highlighted these powerfully. However, we are not fully convinced that primary legislation is the best practical, or most appropriate and proportionate way forward, to achieve the transparency he seeks. My noble friend Lady Sugg also made the same point and pointed to the sensitivity of patient confidentiality in this field. I have highlighted the challenges of collecting data consistently and robustly in this field. Some of those appear to have emerged from the 2017-21 data that was published. While we appreciate what my noble friend seeks to achieve, I hope the Minister will be able to set out how the Government propose to deliver the greater transparency of data that my noble friend seeks through the Bill.

In summary, our view is that improved data collection and reporting does not need to be delivered through legislation, but we urge the Government to do more to rationalise data recording and collection so that proper evidence-based medicine can be implemented. The Government must take steps to ensure data are gathered on a more reliable and consistent basis; the same should apply in this field as across all health aspects in this country. Those responsible for the health of women must do much better; the department must get a grip and give a lead.

The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)

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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.

Lord Moylan (Con)

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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)

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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)

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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.

Baroness Thornton (Lab)

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My Lords, it was a great honour to listen to the last debate. I commend my noble friend Lord Patel for leading a wonderful debate. However, we move on, and I shall explain to the Committee why I am opposing this clause standing part.

First, I have always understood that a Private Member’s Bill in either House should seek to remedy one problem or issue which needs primary legislation to do so. I say respectfully that I do not think that the Bill of the noble Lord, Lord Moylan, fulfils this criterion. It is not a necessary solution to a problem or lack of something, because there is not a problem to be solved that requires primary legislation. That is why I have not sought to amend the Bill.

The reason why there is not a problem to be answered is that the information about complications from all medical procedures, including abortions, are already collected. We might question the efficacy of data collection, the fact that systems do not talk to each other across our NHS, and all of those things; they definitely need to be improved, but we do not need primary legislation to do so. In the case of abortions, it is the only kind of healthcare in the UK that is governed by specific criminal law. Regulations issued under the Abortion Act 1967 require that for every abortion, a woman’s name, date of birth or personal identifier is submitted and provided to the Chief Medical Officer via the abortion notification system. NHS numbers are not required. This data includes complications which are identified before patients are discharged from clinics and the information is managed by the Department of Health and Social Care.

My second reason is, why should abortion be singled out as a medical procedure? This particular and singular primary legislation would require the UK Government to publish

“an annual report on complications from the termination of pregnancy in England”.

Why not knee replacements, appendicitis operations, operations to remove tumours, heart bypasses, cataracts, hernias and the many other everyday or complex procedures, all of which carry both cures and risks which are explained to patients and whose outcomes are recorded?

The Secretary of State will be required in this case to include the complication rate for abortions by the age of the woman, by the method of abortion, by gestation and by complication type as a minimum. The Royal College of Obstetricians and Gynaecologists is very clear that the proposal in this Bill is neither practical nor deliverable and, if passed, this Bill would therefore require the Secretary of State to produce an annual report using data collections that are inadequate to fulfil its aims.

Lord Moylan (Con)

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My Lords, it might be helpful if I spoke next so I could update the House on various developments that have taken place since Second Reading. I am grateful to the noble Baroness, Lady Thornton, for her remarks about the importance of improving data and the importance of that data for women’s health. Nearly all of the other points she made were dealt with and debated at Second Reading, which the noble Baroness was unable to attend.

However, the fact is that there is nothing in the Bill which exceptionalises abortion, because the statistics on abortion complications already have to be collected under the existing abortion regulations using a system that relies on data provided by the abortion provider. That might have been sensible when the regulations were put in place, but currently the majority of abortions take place by the use of pills at home. Therefore, if there are complications, they are presented, in most cases, at hospitals in A&E and they are not part of the abortion notification system, so the majority of those complications are no longer captured by the current system.

The royal college says it is impossible to capture the complication statistics, but it seems to be completely unaware that, in November 2023, the Office for Health Improvements and Disparities produced a report that, with some labour, did actually capture them and showed that it could be done. All that is in this Bill is a requirement that that report, which is being treated by the department as a one-off and not to be repeated, should be repeated. It is wrong to suggest that this cannot be done; it has been done, and it can be done again.

I want to be brief, as I am conscious of the words of the Chief Whip before we started. I will move on to some developments that have occurred since Second Reading, because at the end of Second Reading, thinking that perhaps the Bill would not proceed to Committee, I tabled some Written Questions on this matter. I had one reply from the noble Baroness, Lady Twycross, on behalf of the Cabinet Office, which effectively introduced me to Mr Ed Humpherson, the director-general for the Office for Statistics Regulation, with whom I have since had correspondence.

Before I read from his letter to me of 20 February, I will remark that, as was mentioned at Second Reading, these statistics are referred to as national statistics and they are required to comply with the statistics code. In that light, the last compliance check was carried out in 2012 and because of that, Mr Humpherson says: “We have agreed with DHSC that a compliance check of the statistics would be beneficial”. A great deal of what the Bill seeks to achieve is likely now to be pursued by the Office for Statistics Regulation in consultation with the DHSC. Since it is very unlikely that any compliance check would consider that the current system was successfully capturing complications arising from abortions, I am therefore very pleased with what Mr Humpherson said.

I will continue with his letter a little bit, because my pleasure at his agreement to carry out a compliance check is slightly modified by his timetable and approach. He goes on to say: “We plan to carry out this review in the first quarter of 2026/27, giving DHSC time to undertake its planned developments. These include supporting data providers to move to DHSC’s digital submission system and working with digital experts and system users to improve the design of the Abortion Notification System”. I am certain that the noble Baroness, Lady Thornton, and I would agree that that work would be very welcome. My only quibble with Mr Humpherson—and I have written to him to say this—is that I would have thought the sensible thing would be to have the compliance check first, in order to identify the deficiencies and agree between DHSC and the regulator what the deficiencies are, and then for the department to invest in the digitisation of the collection of the statistics in such a way that they will comply with the regulator’s requirements.

When the Minister comes to reply, I am sure she will say that she will collaborate fully with the Office for Statistics Regulation and its work, because I fully expect the department to do that—it is the responsible thing to do. Can she agree that she will consider whether this is being done in quite the right order? Would it not be sensible to bring the compliance check forward so that the developments being carried out, which will involve investment and time, are not wasted but achieve what the regulator will be satisfied with at the end of the day?

Baroness Finn (Con)

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My Lords, I apologise for not being able to attend Second Reading. I begin with the observation that, as a healthcare service, abortion is highly regulated and subject to the same oversight as any other care. As a result of the Abortion Act 1967, it is also subject to additional oversight which predates many of the regulatory and monitoring systems in place across the health service today.

This context is relevant to the Bill before us, which seeks to build on this 58 year-old framework. I am wholly in favour of monitoring all forms of healthcare provision and entirely agree that further work needs to be done on the collection and analysis of large datasets relating to women’s reproductive health. However, I have concerns that this Bill in primary legislation is not the best way to approach this important work.

I am aware that both the Royal College of Obstetricians and Gynaecologists—the RCOG—and the British Pregnancy Advisory Service have shared with noble Lords their concerns that, as the noble Baroness, Lady Thornton, has said, singling out abortion for new legislation in this way exceptionalises it and fails to treat it like other forms of healthcare. This would potentially stigmatise abortion care for both women and the medical professionals who provide the care. It would also indicate that abortion is considered to be such a high-risk intervention that it is in need of particular oversight.

The RCOG points out that abortion is a “safe and effective procedure”. Some one in three women in the UK will have had an abortion before the age of 45 and international studies have repeatedly found that abortion is of less risk to women than complications that can arise from continuing a pregnancy to term and giving birth. As a result, I am concerned by any indication that this House considers abortion to require increased monitoring and oversight, over and above that of comparable healthcare, and indeed the message that it would send to the nearly 300,000 women who access abortion services across the UK every year.

I agree with my noble friend Lord Moylan that we need to improve collection of data, but this must be done across women’s healthcare more broadly, and I would be interested to hear from the Minister about what plans the Government have to achieve this. We know that in many areas, women wait a disproportionately long time for diagnoses of devastating conditions, such as endometriosis, and in that time often suffer complications that come from lack of treatment.

It was for this reason that the previous Government published the widely welcomed, first ever women’s health strategy for England, to take a holistic approach to women’s healthcare. I pay particular tribute to my former colleague, Emma Dean, for her tireless and excellent work to make this happen. We also appointed the brilliant Dame Lesley Regan as the first women’s health ambassador to support the implementation of this strategy. I was pleased to note that the Minister for Secondary Care confirmed in the other place the Government’s commitment to the women’s health strategy, though I am concerned about the lack of progress against the strategy’s widely welcomed commitments, especially the Government dropping targets for ICBs around the creation of women’s health hubs. The RCOG has said that the existing hubs have reduced unnecessary referrals, provided training opportunities for professionals and enabled women to access support quickly.

The NHS 10-year plan and monitoring of the women’s health strategy would, I hope, offer an opportunity to address the challenge of good monitoring without adding unnecessary legal burdens to the healthcare system. I hope that we can all agree that the purpose of this monitoring has to be to improve information and care for women, and that singling out abortion is unfortunately likely to do more harm than good.

Before I close, I want to touch on the practicality and operability of this legislation. I understand that the information currently used by the department to produce abortion statistics, such as the type of abortion, gestational age, and information about women accessing care, is separate in the majority of cases from a woman’s broader healthcare record. It seems incredibly important to protect this right to privacy for women accessing abortion care, particularly for women at risk of domestic abuse, honour-based abuse or reproductive coercion. I know that my noble friend will not want to place women at risk as a result of this legislation, so I wonder if the Minister can confirm that the department is able to link abortion records with wider healthcare records in the way this legislation would require, and if so, whether that would mean that abortion care would appear on a woman’s medical record, whether or not she had given consent.

Given my concerns about the impact of the proposals in the Bill on women and the wider healthcare system, I am not able to support it in its current form and support the noble Baroness, Lady Thornton, in her opposition to the clause standing part.

Lord Weir of Ballyholme (DUP)

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My Lords, I join others in apologising for not being here at Second Reading—on medical grounds, in my case—which seems to be a consistent theme in this debate. In looking at the amendment and legislation today, it is important that we actually focus on what is there rather than debating—I appreciate that the noble Baroness does not intend to push this to a Division—something that is not there.

Baroness Freeman of Steventon (CB)

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My Lords, as part of my work in Cambridge, which is in my register of interests, I was involved, and still am, in the making of decision aids to help NHS patients make decisions about their healthcare treatments. Part of my work was to find the evidence about the risks and benefits of different treatment options, so I am very familiar with the lack of data in many respects on the efficacy and, in more cases, side-effects of different treatment options.

I would absolutely stand by any Bill that aimed to improve the data for individuals to make decisions, but I do not see why abortion is being singled out in this way in this particular Bill. I am bearing in mind the Chief Whip’s notes, and although I could speak for some time on the lack of data for side-effects in many treatments I will give just two examples. I was involved in the decision aid for osteoarthritis in hips. Hip replacements are an example where, again, we have large numbers of treatments being done outside of NHS clinics. We are really lacking in long-term follow-up, particularly asking patients about the really important patient-reported outcome measures—the things that are important to them. Cataracts are another example. It is one of our biggest and most numerous operations, and more than half of them are done outside of NHS clinics. Again, you would think that actually asking how many people would say afterwards that their vision has improved would be a very basic thing, but we are lacking that data.

I would absolutely love to have more data on side-effects and the efficacies of these things, including side-effects that are not expected and not on the official list to be collected. I did a decision aid on gall bladder surgery. Diarrhoea is a very common outcome of this surgery—in more than 10% of cases—and yet it is not often recorded. Sexual dysfunction is a side-effect of many treatments, but it is not something that patients want to bring up. These are all really important.

There are so many issues about data, but if you look at the data on abortion statistics and complications, you find that the 2023 report is very good. It highlights the numbers that patients would need to make decisions. The rates are not changing every year. We do not update our decision aids every year. The data remains stable, unless there is a very dramatic change in clinical practice.

I would absolutely support the better collection of data, and I am hoping there are opportunities to do that in the future. But on this particular occasion, I very much support the noble Baroness, Lady Thornton.

Baroness Lawlor (Con)

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My Lords, I do not support the noble Baroness’s opposition to Clause 1 standing part of the Bill. My noble friend Lord Moylan has mentioned the 2023 analysis by the Office for Health Improvement and Disparities. It based its evidence solely on NHS England statistics: the database of admissions, A&E attendance and outpatient appointments. Using this data, different outcomes were recorded. It used only the data contained in records for patient admissions and for abortion-related complications as the primary or secondary diagnosis, not those for incomplete abortions that did not have a further complication. We see, therefore, that the complication rate varies depending on the evidence that is before the statistician.

For these reasons, there is little disagreement among the groups concerned that we all, whether parliamentary or non-parliamentary, want good data collection. Some of us are more concerned with data collection on one kind of procedure, and others with another, but, now that we are updating and digitising the NHS system, this seems an opportunity to improve data right around the system. But this should not be excluded, and I do not think that noble Lords should suggest an exception. It is an exceptional thing to require accurate data where possible and where it can be obtained, so that we can use the digitisation of the system to encourage the best statistics.

My noble friend referred to some of the changes that we have seen. The position has changed since the statistics were last checked for compliance with the code of practice for statistics in 2012, with the increase of medically induced abortions from 48% to 85%. In England and Wales, 75% of abortions were completed at home. As a result, complications may not be recorded on the HSA4 forms that are the basis for the present statistics under the abortion notification service. With women administering medication at home, if there is a complication, they may go to their GP surgery, dial 111 or go to A&E. The fact that these episodes are complications will not necessarily be recorded on the HSA4 forms that are used to compile the reports we have. But it has been used, which is why I find this a statistically interesting debate, by the 2023 analysis, which I mentioned on opening, and it can be used.

For these reasons, I welcome that the statistics regulator is going to check on the compliance and that the Department of Health and Social Care has agreed to this—I applaud that. The timing is quite important. As the NHS system is digitised, it can prepare things so that the records can be read digitally, accurately and cheaply, with the data on complications from abortions entered into the system. I suggest that, as my noble friend Lord Moylan proposed, the compliance check should be instituted in advance of digitisation so that the statistics authority can then report on—and, as a result, the Department of Health can be made aware of—where and what digitisation is needed, so that the records can be used in digital form cheaply and with the transparency that we need for statistics. This will save money on any further necessary updates later.

I do not take the point that some noble Lords have made about confidentiality. Confidentiality is extremely important—I agree with all confidentiality requirements; it is vital if one is to have trust in one’s health service and provider—but these things are done by codes. As far as I know—I ask the Minister to correct me if I am wrong—every operation has codes. People are not named, but there are codes for referring to whatever procedures take place. This is very useful for digitisation.

Baroness Bennett of Manor Castle (GP)

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My Lords, I offer Green group support for the proposition from the noble Baroness, Lady Thornton. I almost feel that I do not need to, given that the noble Baroness, Lady Freeman of Steventon, very powerfully made the argument that the Bill unnecessarily exceptionalises abortion when there are very comparable procedures conducted in similar procedural ways—hip replacements and cataract operations. Yes, we need to improve the collection of statistics, but we do not have a Bill before us to do that. By definition, the exceptionalising that is going on is very obvious.

I want to pick up on two comments made by the noble Lord, Lord Weir of Ballyholme, and most respectfully to disagree with him. The noble Lord said that what is happening in the US is not relevant here. I spoke at Second Reading about the influence and money flowing from the United States of America into the UK. I can update your Lordships’ House on that. I was going back as far 2014, and a chapter of a book I wrote addressing these issues. This has been highlighted by Peter Geoghegan, who wrote Democracy for Sale, and others. The so-called Alliance Defending Freedom from the US provides massive funding. In 2020, it put £324,000 into a similarly named organisation in the UK. By 2024, that had risen to £1.1 million of the organisation’s total income of £1.3 million. We are debating this Bill in the context of that flood of US money seeking to influence what is happening in the UK.

I put Written Question HL6542 to the Government about this. I am afraid that the Government are not taking this with the seriousness that it deserves for defending our democracy. The Answer referred to lobbying of the Government and what measures the Government have in place. We need to think about the measures that we need across our society to deal with the inequality of financial arms that is occurring in these debates because of the money flooding in from certain forces within the US.

The noble Lord, Lord Weir, also said that the context did not really matter. However, this Bill appears before us in the context of more than 60 MPs in the other place backing one amendment—there is another one too—to decriminalise abortion, to end the exceptionalisation of abortion right across our law. That would make this Bill look particularly strange and ill-fitting. For those reasons, I support the proposition from the noble Baroness, Lady Thornton.

Baroness Brinton (LD)

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My Lords, unfortunately, I too was unable to be at Second Reading. I speak today to support the stand part notice from the noble Baroness, Lady Thornton, and on what the noble Baroness, Lady Finn, said about the important review of data collection—actually, across the health sector, as I will explain, but particularly of data relating to abortions.

The noble Baroness, Lady Thornton, spoke of how some elements of this short Bill are inconsistent, which makes it unable to deliver what the noble Lord, Lord Moylan, hopes for, despite what he said—I will come on to explain why—even if it were the right thing to do. I agree with the points that the noble Baroness, Lady Thornton, made.

One issue at the heart of this inconsistency is the use of patients’ confidential health personal data. There is an absolute presumption by patients that their health personal data will always be kept confidential between them and their medical practitioners. Indeed, noble Lords may remember, when the then Government proposed care.data plans a few years ago, it became clear that we were likely to move to a US-type system of allowing researchers, insurers et cetera access to anonymised and pseudonymised data. I can tell the noble Baroness, Lady Lawlor, that, during that debate, it was important to note that it is possible to reverse most anonymised and pseudonymised data, particularly when dealing with an unusual circumstance. Once you have one or two identifiers, you can get to a very small geographic position very quickly—sometimes to a postcode, frankly. Therein lies the problem: confidentiality is lost.

More worrying were the original proposals in the Bill that became the Police, Crime, Sentencing and Courts Act 2022, which gave the police and the Home Secretary—then Priti Patel—the power to demand from any relevant person or authority, which included health authorities at the time, to see data that might be of interest in an investigation. I was working on that Bill and, when I queried this power in your Lordships’ House, it transpired that it was not just for suspects of crime but for anyone connected with the incident, who might or might not be a witness. That went completely against everything in a doctor’s sacred oath of confidentiality with regard to their patient. I am pleased to say that, following my amendments to that Bill and pressure from doctors, the then Clause 16(4)(a) was modified to prevent access to health data compared to data from other bodies, where it still sits.

That was followed by a debate, on the Health and Care Bill, about the use of patients’ personal health data for research. My noble friend Lord Clement-Jones, other noble Lords and I made it very clear that assuming that anonymised or pseudonymised data could not be reverse-engineered was not acceptable. Out of that, a new system of a black box, where the anonymity of patients is guaranteed, was introduced.

However, abortion data is different because it is not within these safeguards. The Abortion Act 1967 requires that the woman’s name and date of birth or a personal identifier must be submitted on every abortion and provided to the Chief Medical Officer via the abortion notification system. While, as others have said, this data includes complications prior to discharge, the “Hospital Episode Statistics” referred to in Clause 1(3)(b) of the Bill from the noble Lord, Lord Moylan, are based only on abortion data from trusts, which are not linked to abortion records. This means that the data is coming from two different sources, which are collecting different data. As the briefing from BPAS tells us, neither dataset actually captures all abortion complications, nor can the hospital episode statistics be analysed by methods of gestation or abortion—another difference, yet again. I do not think that the noble Lord, Lord Moylan, covered that point of disparity when he spoke earlier. My worry is that the annual report would not actually reflect the wider picture.

The second issue that I will raise is of those other delicate areas that might inadvertently be drawn into this type of reporting on complications of abortion. In the debate earlier today in your Lordships’ House, we discussed miscarriages and preterm births. Nearly 50 years ago, I had an early miscarriage and, when I went to the hospital, I was told that I was having a “spontaneous abortion”—a ghastly phrase. I still had remnants inside my body that needed to be removed to ensure a “complete abortion”—an even more ghastly phrase. In the middle of my grief at losing my first baby, the medics were talking about “abortion”.

The very helpful briefing from the Royal College of Obstetricians and Gynaecologists points out that the differing terms that can be entered into hospital coding are “induced miscarriage” and “spontaneous abortion”. It says:

“This can result in a code being applied for an abortion complication when it should have been for a miscarriage complication and vice versa.”


This is not just about words such as “spontaneous abortion”. Following on the speech from the noble Baroness, Lady Bennett, in the USA, since the Dobbs case, miscarriage has increasingly been brought into the debate about abortion. West Virginia has one of the toughest sets of abortion laws, allowing it only for cases of rape, incest or if the woman has an ectopic or totally non-viable pregnancy. But it gets worse. Last week, in Raleigh County, West Virginia, the prosecuting attorney, Tom Truman, advised women to get in touch with police, law enforcement or a doctor if they were worried that they might be charged with mishandling foetal remains. The example cited was the arrest of a woman for disposing of foetal remains in her bins. He said that a number of criminal charges under state code, including felonies, could be levied against a woman who flushes foetal remains, buries them or otherwise disposes of them following an involuntary abortion, also called a miscarriage. A West Virginian woman in my situation, which I talked about earlier, could well be prosecuted. The miscarriage that I referred to is not unusual. I lost the tiny foetus down the toilet, and I was distressed beyond measure. In West Virginia, you would now have to retrieve the foetal remains or be at risk of prosecution.

I am sure that there is absolutely no intention in the UK for this to happen, but the debate happening in the US is beginning to colour the debate we are having here. I am very clear that the problem is that some people want miscarriage to be treated as suspicious. They clearly are not medics. It is thought that 15% to 20% of pregnancies end in miscarriage. It is surprisingly common, and good luck to that prosecutor in West Virginia. He is going to spend his entire time on people reporting miscarriage. Above all, the issue of miscarriage and spontaneous abortion is yet another that muddles the data proposed in this annual report and demonstrates, sadly, that it is not fit for purpose.

Baroness Miller of Chilthorne Domer (LD)

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My Lords, I was here for Second Reading and I was here to hear the noble Lord, Lord Moylan, tell us about how the abortion landscape is shifting quite rapidly. Between Second Reading and today, we saw a vivid example of just how that landscape is shifting and why it needs to shift very rapidly, because we saw the conclusion of the trial of Nicola Packer. Thankfully, the jurors recently cleared the 45 year-old of illegally terminating her pregnancy. She suffered more than four years of police and criminal proceedings.

In fact, the number of women being prosecuted on suspicion of breaking abortion laws has increased over recent years, so the landscape is getting worse. That is partly why I am very pleased to support the noble Baroness, Lady Thornton, in opposing the clause standing part, because the Bill does nothing to improve the abortion landscape. Personally, I am quite surprised that the noble Lord, Lord Moylan, has brought it back today to Committee, because it was made evident to us at Second Reading by the Minister and other speakers, including my noble friend Lord Scriven, that it was absolutely unnecessary and very unhelpful. Indeed, we heard from the noble Baroness, Lady Freeman of Steventon, today exactly why that is.

I hope that this House will soon have the opportunity to debate and enact real change, along the lines of the two amendments tabled in the other place, referred to by the noble Baroness, Lady Bennett. I want to check something with the noble Lord, Lord Moylan. He said at Second Reading—and I expect he is thinking it again today:

“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 ... If I thought I was surrounded by conspiracy, I would want to live in a world of facts and not hide myself from them”.—[Official Report, 13/12/24; cols. 1994-5.]

Baroness Barker (LD)

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My Lords, I, too, spoke at Second Reading and I welcome the opportunity to speak again to set in context what the Bill is part of and is all about. I, too, have to disagree fundamentally with the noble Lord, Lord Weir of Ballyholme, though not on the necessity for accurate data and statistics. You cannot separate the Bill from the wider context of what is going on in the politics of reproduction, reproductive health and gender identity.

I spoke last time about the international campaign being organised largely by religious nationalists across the USA, Europe and Russia, which has a specific aim to destroy human rights, reproductive rights and the international organisations responsible for upholding them. If people wish to doubt me, I suggest they read any number of reports, but the one that sets out the fundamental basis of the campaign is from 2018 by the European Parliamentary Forum on Population and Development, Restoring the Natural Order, which sets out how a small group of people have set out to overturn the human rights framework that we developed following the horrors of World War Two and over the past 50 years in order to “restore the national order”. They have a number of specific objectives within that. Key among them are making sure that the definition of marriage and family pertains only to heterosexual people, and definitely overturning access to abortion and contraception. Overturning divorce laws is part of what they want to do as well as rejecting compulsory sex, reproductive and health education and, perhaps most interestingly of all, making sure that the first and primary educators of children must always be the family, even if that is to the exclusion of public education. It is a clear agenda.

The noble Baroness, Lady Bennett, was right. If you want to see how it is unfolding, just look at what is happening in states in America and in Hungary and Poland, because what is happening in the USA is not stopping there. It is funded by billions upon billions of dollars in Europe, mostly emanating from America but also from Russia, and in Africa. This is part of that.

It is important and relevant that we look at that today because the data you get relies entirely on the questions you ask, and the questions you ask are determined by the outcomes you want to achieve. As some of us watch this campaign unfolding in its different manifestations, one thing we have noticed is that it is moving on. The people behind it—the Alliance Defending Freedom, the Heritage Foundation and all those massive Christian nationalist organisations and Catholic and other religious institutions in Europe—have realised that, to make to make their campaign more widely palatable, they have to move away from being largely a bunch of male-led organisations. They have removed themselves through a number of different front organisations and changed the language they use to talk about rights and so on.

From those of us who have fought for human rights for 50 years, they have learned the importance of having your messages framed in terms of rights—the rights of people to resist a liberal elite that argues for things such as equality and equality laws, which are inevitably disproportionately affecting some people, particularly poorer people. They say, “Rather than relying on what we’ve done so far, we actually need to go further. We need to create the information that will back up our campaign”. Interestingly, in some cases they have set up private universities which produce research that appears to be proper academic research but is in fact grey research, always leading inevitably to the conclusions that support their back-up. They produce books and reports. This is not new. Noble Lords in this House have for years seen the dodgy dossiers that come from the Christian Institute—all that kind of stuff. That is what is happening and that is why it is important that we make sure that the statistics that we get on abortion—and, incidentally, access to contraception—are timely and accurate.

Noble Lords have mentioned this, and they are absolutely right: the politicisation of data in this area is really important. The increase in the number of women being prosecuted because they have had a miscarriage comes as a direct result of this campaign. I do not think that those of us on our side of the argument have anything to fear. We kept statistics when we introduced telemedicine and medical abortion. In advance of it, those on the other side of the argument were full of dire warnings that all sorts of crimes would be committed. They were not; the statistics and the data have shown that.

I have nothing against the improvement of the collection of data in the health service, but my plea to the noble Baroness, Lady Merron, is that, when the Government look at this issue—and I believe that we should—I ask her to ensure that the statisticians are able to resist the political pressure being exercised across all the different parts of government and organisations because of this campaign, which is being waged on a number of different fronts. Ultimately, it is a pernicious campaign that will damage all sorts of people, including minorities, but will be particularly harmful to women and girls.

Baroness Boycott (CB)

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My Lords, I join this debate to follow up the powerful speech by the noble Baroness, Lady Barker. I have been involved in women’s rights for a very long time; I started a magazine called Spare Rib in 1972 and within that we campaigned all our lives for things such as abortions. I can honestly say that I think the life facing a young woman today is more frightening than the life that faced me as a young woman.

I look at what is happening online, where you can download a very simple app. I had a lunch for Laura Bates the other day, which many noble Lords came to. She explained that I could download an app, take a photograph of the noble Baroness, Lady Freeman, right beside me, press a button and have a photograph of the noble Baroness naked—not with Kate Moss’s body, but with the noble Baroness’s body. You can do this at 11 or 12. It is really threatening being a young woman today. There are many things that are out of our control. We, as older women who have had successful lives, have to fight fantastically hard to protect this next generation from a lot of the stuff that is coming down the pipe.

I very much listen to and know about the conspiracies and the power happening in America to try to alter fundamental rights such as abortion. I find it extremely distressing that measures such as this should come to the House of Lords and even be debated seriously, and that there should be a politicisation of women who face abortion. Frankly, nobody wants an abortion; I cannot think why people ever thought that. Nobody wants one. There are several things you do not say when you ask yourself, “What do I want to do in my life?” No one says, “I want to be an alcoholic”, or, “I want to have an abortion”, or, “I want to be a druggie”. You do not put those on your wish list. They happen and we should protect women and support them all the way through, as the noble Lord, Lord Patel, spoke about in his fantastic debate earlier. These are people who need our protection and our love. I really support the noble Baroness, Lady Thornton, in bringing this forward. I will take part in any further debate because this is vital, and we are vital to this. Our voices really matter here.

Lord Sandhurst (Con)

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My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures.

It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions.

At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting

“the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.]

but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally.

In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it.

Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.

The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)

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My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords.

The stated main purpose of the Bill 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”.

The purpose of such an annual report, as I understand it, would be

“to inform policy and safe practice regarding the termination of pregnancy”.

I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.

Lord Moylan (Con)

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For clarification, is the Minister saying that the digitising and adapting of the abortion notification system that her department plans to carry out will be done in collaboration with the Office for Statistics Regulation? Or is the intention that the department does the work in its own box, so to speak, and then the Office for Statistics Regulation comes in and checks it? She seemed to hint that, for the first time, it might be the former, which would be quite encouraging.

Baroness Merron (Lab)

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As I said, we are developing work with the OSR. As with all ways of developing work, that means working in a way that will get us to the place we wish to get to. I do not quite recognise the latter way forward that the noble Lord referred to, but I will be happy to write him further on this matter.

I can assure the noble Baroness, Lady Finn, that our focus in the women’s health strategy is on turning those commitments into action. I draw the noble Baroness’s attention to the provision of free of charge emergency hormonal contraception at pharmacies from October this year. We are also setting out how we will eliminate cervical cancer by 2040 through the new cervical cancer plan, we are and taking urgent action to tackle gynaecology waiting lists through the elective reform plan. Those are all tangible improvements to women’s health. I assure the noble Baroness that the women’s health strategy is very much kept under review to see how and where it can be improved.

The noble Baroness, Lady Finn, asked about the linking of records. It is not currently possible to link the abortion notification system with wider health records data, because of the unique identifiers on the abortion notification system data. However, as I said earlier, we are reviewing the wording of the form so that it will be easier for clinicians to complete, which will, I hope, bring about some improvements.

I say to the noble Baroness, Lady Freeman, that the Government are focused on moving the NHS from analogue to digital across all areas of healthcare, in order to provide the improved data collection that many noble Lords have called for during the debate.

The noble Baroness, Lady Bennett, called on the Government seriously to consider the implications of money flowing in from the USA with a view to obtaining influence—a point also referred to by the noble Baronesses, Lady Brinton and Lady Barker. I can confirm that this matter is being considered more widely across government.

As noble Lords may remember, the Government have expressed reservations about the Bill as legislation is not required to produce an annual report. We believe that the aims of the Bill can be achieved through existing routes, thereby rendering further legislation unnecessary. In 2023, the department published a report on abortion complications and could choose to do so again. However, it has no plans to publish ongoing separate additional annual reports on abortion complications as there is no operational need to do so. I hope noble Lords will understand—some have made this point—that we have to uphold a duty of care not to legislate when other reasonable processes are available, as there are in this case.