Complications from Abortions (Annual Report) Bill [HL]

Baroness Freeman of Steventon Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

When we get that data, it may produce inconvenient results for some of us. It may well be that some of us who would argue for a different regime for abortion, for example, may find the figures very inconvenient. But the mark of a tolerant and open society is tolerating a wide range of opinions and sometimes dealing with inconvenient opinions. If we can deal with inconvenient opinions, how much more important is it to deal in facts and evidence? It seems to me that, at times, we may be faced with inconvenient facts and evidence, but the stronger and more reliable those facts and evidence, the better. That is why I believe that this is a productive way forward, and why I am not minded towards the opposition to the clause but am supportive of the original wording of the Bill from the noble Lord, Lord Moylan.

[Baroness Freeman of Steventon (CB)]

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)]

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.

Food, Diet and Obesity Committee Report

Baroness Freeman of Steventon Excerpts

Friday 28th March 2025 Lords Chamber

[Baroness Freeman of Steventon (CB)]

My Lords, I listened to all the oral evidence to this inquiry while making it into a podcast. It was shocking, depressing and inspiring. We have already heard the shocking part: the statistics—the numbers of people suffering, the cost to the NHS and the cost to the economy of diet-related illnesses keeping people out of work. The depressing part of the evidence was hearing about our repeated failure to even slow down the train wreck.

The reason we have an obesity problem now compared with 40 years ago is that food has changed—not us, and not our willpower or our genetics. The challenge, then, is how we reduce the amount of unhealthy food and drink that we all consume. That is how we will eliminate these diet-related illnesses. However, the aims of the Government’s food strategy—noble Lords can read them—do not mention reducing unhealthy food in our diets at all, only making healthy foods more affordable and accessible. This in itself will not make the difference that we need to see.

It is pretty clear what healthy food and drink look like. People can try to split hairs and draw lines, but we all know it: whole foods, variety, minimal processing, less meat, and lower salt, fat and sugar. And we all know what unhealthy food looks like. Why are we not eating the good stuff, and instead eating the bad stuff? In most of our day-to-day lives, we do not have the time, money or resources to cook with fresh, whole-food ingredients for every meal of every day. The inquiry heard how kitchen equipment, the cost of heating an oven, and the space for food storage and preparation are prohibitive to many, as well as how quickly most fresh ingredients and freshly made foods go off, risking expense and waste.

The industrial food chain has grown into this space, producing ready-to-eat, long-life foods at affordable prices. However, these are not just convenient versions of traditional dishes; they are designed to be very tasty—we all know that—but they are also mostly very unhealthy. Their design is around palatability, not nutrition, and profitability. Being profitable, they are marketed to us aggressively. The more time-poor or financially poor that you are, the more they are marketed to you.

The impact of industrialised food on our health sits alongside the terrible impact on the environment, animal welfare and farmers’ livelihoods. Surely, then, the Government’s food strategy should be asking how we can efficiently produce and distribute freshly made meals, ideally from mainly British-grown ingredients, to replace as much as possible of the industrial stuff.

From listening to the evidence to the inquiry, I know where I would start. Where do a known number of people eat, every day, all in one place, allowing a relatively easy calculation of how much fresh food needs to be prepared, minimising wastage and transport? It is in schools—where this is very much needed. The committee heard not only that nearly one in four of our children are clinically obese by the age of 10 but that they are stunted by malnutrition—UK children are up to 9 centimetres shorter than their peers in northern and eastern Europe.

Here we come to where the committee evidence was inspiring. We heard about local schemes, where schools hosted kitchens that supplied freshly prepared, freshly cooked, healthy meals for all the children—100% attendance—as well as selling to parents and the local community, meaning that they could do all this within current authority finances. There is evidence that this reduces obesity. There are myriad other innovative ways to get fresh produce from our farms to our forks, with as little in between as possible. This is the sort of thinking and supply that small, local businesses and communities excel at. The committee heard about many.

However, last week, my depression returned. The Government announced the advisory board for its food strategy—the strategy that does not mention reducing unhealthy food. On the board is one solitary farmer; there is no one who cooks fresh food, no one who is an expert in school meal provision, and not even a biodiversity and conservation expert, even though one of the stated aims of the strategy is to work out how to reduce the impacts of our food system on the environment.

Another of the aims is economic growth. Economic growth could mean the encouragement of innovative local and community SMEs and family farms—British businesses that employ locally and supply locally. But no: the board is almost all made up of representatives of multinational industrial foodstuff manufacturers and retailers, as is its secretariat—the people whose businesses are the antithesis of what a healthy food strategy needs.

The strategy says that it aims to ensure that

“our largest manufacturing sector can realise its potential for economic growth”.

I emphasise “manufacturing”. That is how this Government see food: not in terms of growing, preparing, cooking, health or the environment, but manufacturing. That is the sort of thinking that has caused successive Governments to fail the citizens of the UK and fail to stop the ever-increasing illnesses from poor food.

I therefore have some questions for the Minister. Why does the government strategy not consider reducing unhealthy food in our diet a priority? If it does, why does it not state that? How were the members of the advisory group chosen? Why is there no representation in the group of those who specialise in cooking or supplying food made from fresh ingredients? Why is there no expert in biodiversity in the group, despite that being a stated priority? Will the minutes of its meetings be made publicly available? Will those contain agreements on key targets to be reached on reducing diet-related health problems, as well as on biodiversity, so that we can be sure that the strategy is focused on the outcomes that we all want to see?

I end with a plea: please listen back to the evidence given to this inquiry. Do not let all those inspiring people down by making the same mistakes that we have made, decade after decade, by not tackling the real problem: industrialised food.

NHS England Update

Baroness Freeman of Steventon Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.

[Baroness Freeman of Steventon (CB)]

My Lords, since NHS Digital was merged with NHS England, NHS England staff have been running absolutely critical data and digital infrastructure. During this period of uncertainty, we are bound to be in danger of losing some staff with expertise that is difficult to replace. What are the Government doing to make sure that these jobs are absolutely safeguarded and that this expertise is not lost?

[Baroness Merron (Lab)]

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.