Pregnancy Counselling

Debate between Anne Milton and Thomas Docherty

Monday 12th December 2011 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I thank the hon. Member for Luton South (Gavin Shuker) for bringing this important issue to the fore in the House again. It is testament to how important the issue is that, at this late hour, the House is filled with many Members who take an interest in it. People rightly feel very strongly about it, and he has made some very important points. In this debate, whatever our respective positions, I think we all agree that women who face a decision about whether to proceed with their pregnancy need support, advice and, indeed, counselling; often, it is a very difficult decision for women to make.

The hon. Gentleman supported the amendment introduced by my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries), and since that debate officials in the Department of Health have been developing and looking at proposals for a consultation on the counselling options in the independent sector and in the NHS for all women considering abortion.

I am working with Members from both sides of the House to look at how we might proceed with the consultation, and I have been impressed by what the hon. Gentleman referred to as the “maturity” of that group of people, who, despite starting from quite opposite ends of the debate, have come together to find out where we agree and, at the end of the day, to ensure that we put forward a consultation that looks at what is best for women.

The consultation will consider how to develop an offer of counselling that is impartial and supportive and, as part of the process, we will look at who is best placed to offer counselling. It is not about automatically including or excluding any one type of organisation; what matters is that we define clearly the outcomes that we want for women. It is important to focus on the process, but we need to be clear about what we are trying to achieve.

Officials have visited several counselling providers to find out more about the services that are offered in terms of the process, the qualifications that their counsellors hold, and what people should expect on booking a counselling appointment. Some organisations are abortion providers, some are services that refer people to abortion providers, and others do not make direct abortion referrals. Official recently visited a Marie Stopes International clinic and a BPAS clinic, and what they found was quite interesting. During the consultation, I am sure that we will hear from many other people with experience of those services.

The proposals are still being developed, and, on an issue that has sought to divide the House in the past, and on which there are sometimes very strong views, it is important that we go into the consultation with one mind. We are confident that, as a result of the work, counselling arrangements will be improved. That is the purpose of the work, and we want to take into account everyone’s point of view so that we put together for consultation the right document that asks the right questions and includes the right options, and so that we hear and know exactly what is the best way forward.

It is clear that good work, delivered by different providers, is going on in many places, but we need to make sure that all women are offered a consistently good service. The repercussions of that not being the case are very serious. The aim of the consultation will be to propose ways to strengthen existing counselling options for women where they are good, improve the services where they fall short, and set out detailed options to achieve that goal.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

I commend my hon. Friend the Member for Luton South (Gavin Shuker) for securing this well-measured debate. The Minister will be aware that the Health and Social Care Bill is going through the House of Lords. Will she guarantee that before the Bill leaves the other place and comes back here, she will bring forward a measured package to make sure that there is a consultation about these issues?

[Anne Milton]

I thank the hon. Gentleman for his intervention, but there is no need for this to be dealt with in legislation. Before today, I have given my word at this Dispatch Box that we will carry out the consultation and bring forward the best options in finding the best way to make sure that women have an offer of counselling should they wish to take it up. It is important to remember that women who access services sometimes do so from a wide variety of directions—they may self-refer or come from their GP. What matters is that we get the offer in the right place. We need to consider whether the woman should have the one offer or whether the offer needs to be continually open because she might turn it down in the first instance, at the first appointment, but want to take it up, say, a week down the line. It is important that we get the detail right. We do not need to put it into primary legislation; in fact, it would arguably be inappropriate to do so. I repeat that I have said from this Dispatch Box, on more than one occasion, what we will do.

As the hon. Member for Luton South said, there is concern that there is a conflict of interest in that counsellors are paid for procedures and yet also expected to provide entirely impartial advice to women. Although there are no formal quality standards in place for counsellors and no minimum standards for training or qualifications, we have found that the majority of counsellors who work in independent sector abortion providers are registered with the British Association for Counselling and Psychotherapy. Underpinning membership of, and accreditation by, this organisation is a thorough ethical framework that counsellors must abide by. However, sufficient concern has been expressed, so we are looking at everything in the round to make sure that the sector is not only independent but has the confidence of the public that it is independent. It is important to say that independent sector abortion providers and organisations that refer women for an abortion are subject to the Secretary of State’s approval and monitoring by the Care Quality Commission. Marie Stopes International, which is one of the leading abortion providers, has reported that 20% of its clients decided not to go through with the termination following counselling. That is an interesting statistic.

Pregnancy counselling is about providing women with a non-directional and non-threatening service in which they can explore the issues. Some will immediately decide on their course of action, and others will still be unsure about what to do at their first appointment with a health professional. This can sometimes make it very difficult to provide the uniform standard of care that is so important. What is right for one woman will not necessarily be right for another, and so a flexible service that can respond as far as possible to individual women’s needs is essential. Moreover, we do not want to create barriers or to instil delays in the service. Counselling can help a woman to recognise conflicting emotions and feelings and allow her to accept that there may be no perfect, straightforward answer to this crisis in her life. Most importantly, it allows her time and space to reach an informed decision. There is evidence that counselling can help women, particularly vulnerable women, to make a decision with which they are comfortable. We have also heard anecdotal evidence from women who feel that they could have been helped by counselling before making their decision to have an abortion.

Counselling must be balanced. Effective counselling must be confidential, non-directive, non-judgmental, supportive and understood by the person to be independent of any assessment for legal approval for abortion. It needs to happen away from the influence of family or friends. The hon. Member for Luton South highlighted the case of a woman who felt pressurised by her boyfriend and I know that some women feel pressurised by their families.

Contraception has been free on the NHS since 1974. It has helped millions of people to avoid unintended pregnancy and to plan their families as they wish. There are 15 methods of contraception and we have seen a recent increase in the number of women choosing highly effective methods of long-acting contraception.

Although abortion rates for all ages have remained stable, between 2007 and 2010 the abortion rate fell for those aged 24 and under, and the number of abortions overall fell. In 2007 there were just shy of 200,000 abortions, whereas in 2010 there were 189,574, which is a decrease of nearly 10,000 in the space of three years. That is good, but we clearly have a great deal of work to do. Ideally, we do not want to face anything near those numbers. We must ensure that young people have good relationships and sex education so that they can make good choices for their lives.

In conclusion, this work is about ensuring that all women considering an abortion get the best possible service, which they not only need, but deserve. We are looking to build on the recent early successes of the increasing access to psychological therapies programme and to use that model to develop options for pregnancy counselling. We have had discussions with the officials leading that team in the Department and there is a lot of opportunity. I have no doubt that when we offer young women counselling, it will be an opportunity for some women to unearth all sorts of other issues in their lives, such as domestic violence and sexual abuse. I hope that all Members agree with the principle behind this, as I think they do, even though we sometimes disagree about the small print. I hope that the hon. Member for Luton South and all hon. Members will continue to work with us to get this right.

[Anne Milton]

As I have said, I am working with Members on all sides of the debate to get the consultation document right, with the right options and the right offer. The consultation will last for 12 weeks and I then hope to bring forward the arrangements. There are issues with the number of counsellors who are available and with the pathways. These things never happen as quickly as I would like. I always wish that things could happen yesterday, but sadly they cannot.

[Thomas Docherty]

Will the Minister confirm whether she thinks that it will happen before or after the Health and Social Care Bill passes from the House of Lords?

[Anne Milton]

It is not for me to prejudge the passage of any Bill, particularly when it is in another place. I am determined to get on with this work. It is not dependent on the Bill. We need to move forward so that we can get the process in place for the offer to be made as soon as possible.

The hon. Member for Luton South rightly said that no one is neutral. We want women to receive advice on all the available options and to get support in making their decisions. We want them to have the offer of independent counselling so that when they make a decision, they feel sure in their hearts that it is right for them not just for today, but for the rest of their lives.

Question put and agreed to.

Umbilical Cord Blood

Debate between Anne Milton and Thomas Docherty

Monday 31st January 2011 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I thank my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this debate on a topic that is vital. He is right to state that this is yet another opportunity to highlight the issue. All opportunities are useful to raise it in the minds not only of those in the House this evening, but of the public and of those in a position to influence what goes on.

The Department recognised the importance of this issue when it asked the NHS Blood and Transplant Authority to review the UK’s collection, supply and use of stem cells from both bone marrow and umbilical cord blood. The general consensus was that the UK Stem Cell Strategic Forum did a superb job on the review. Its report, which was published in December last year, involved a well thought through, strategic and costed analysis. It provided us, probably for the first time, with an honest appraisal of the use of stem cell units in the UK in the public and charitable sectors. Unfortunately, as is often the case if such reports are honest and frank, some of it made uncomfortable reading.

The review found that the delivery of stem cell units for transplant in the UK is not as efficient or effective as it should be. As my hon. Friend stated, we lag behind many other comparative countries, including Germany and the United States. Some 400 patients each year fail to find suitable donors. Then delays in the system mean that those who find a donor are sometimes, sadly, much too ill to receive a transplant. For these patients the prognosis is very poor.

As the hon. Member for Hackney North and Stoke Newington (Ms Abbott) pointed out, for patients from a black or minority ethnic background, the problem is compounded by the lack of donors or suitable stem cell units available in the first place. Disadvantaged from the outset, their chances drop drastically. On average, about 90% of Caucasians can find a suitably matched donor, compared with only 30% to 40% of those from other ethnic backgrounds. That is unacceptable and pretty shocking. As I said when I announced the report’s publication at a meeting of the all-party group on stem cell transplantation, I am determined to do all that I can to see services improve. I want service providers to develop plans for providing the most effective and efficient service possible in the interests of both the patient and the taxpayer.

My hon. Friend has highlighted a rapidly developing area. Some progress has been made, but it is going at an extraordinary pace. The report not only highlighted what needs to be done, but contained 20 recommendations for the improvement and development of services for the benefit of patients. They include comprehensive changes to the way services are delivered, with a view to establishing the UK once again as a world leader; a more streamlined collection, processing and delivery service, with much more of a focus on results, rather than process; and a radical reconfiguration of transplant services.

The greatest improvements and the quickest gains will be delivered by better bone marrow and umbilical cord blood stem cell services. By making services more efficient, we will see a marked improvement in the treatment, care and support received by patients. We will be able to reduce the time it takes to find a matching donor, address any inequalities in the current system and provide a better service with fewer resources. That will lead to better quality, better management, better planning, better delivery, better outcomes and, crucially, more lives saved. We want those principles to be diligently and consistently applied across the board. The objective is clear: to improve the life chances of those in need of a stem cell transplant.

A considerable amount of work has been done behind the scenes since the publication of the report to see that vision implemented. I have asked officials to work with the forum, NHS Blood and Transplant and Anthony Nolan to develop ways to get a single bone marrow register and cord blood inventory for the NHS in England. We will explore what can be achieved by collective effort, using what is already available and planning for the provision of future services.

[Thomas Docherty]

Further to that point, has the Minister had any discussions with the Scottish Government on their plans for ScotBlood, which is the equivalent service in Scotland? Does she agree that the solution is to have a single register for the whole UK?

[Anne Milton]

There is no doubt that close discussions with all the devolved Administrations are critical. We have a patchy and disjointed service, but as the hon. Gentleman rightly says we need a single register. I am pleased to say that some work is already bearing fruit. At the last meeting of the forum, well-advanced plans were put forward on how NHSBT and Anthony Nolan can work together in future, with targets for reducing the average search time by six weeks and the establishment, for the first time in England, of a single bone marrow register and cord blood inventory. However, we must go further. I cannot praise enough that type of innovative and professional approach. It is collaboration like that that means real improvement for patients. We must have notable improvements on the wards, not just on the spreadsheets.

The UK Stem Cell Strategic Forum review was a Department initiative, and the work was paid for by the Department. We have heard of the efforts of organisations such as Round Table. I would like to take the opportunity to thank Lynda Hamlyn, the chief executive of NHSBT, Henny Braund, her counterpart at Anthony Nolan, and their dedicated, hard-working staff for the work they have done so far. I have no doubt that there is more work to be done and that it will continue in the future.

Termination of Pregnancy (Information Provided)

Debate between Anne Milton and Thomas Docherty

Tuesday 2nd November 2010 Commons Chamber

[Anne Milton]

Yes. I thank my hon. Friend for raising that point. The issues raised by conflicts of interest and hiding behind commercial sensitivity give rise to considerable concern. That is why I am pleased to be meeting some of the service providers in the next week or so to discuss those issues. It must be pointed out, with the greatest respect to my hon. Friend the Member for Mid Bedfordshire, that although the stories she talked about involved bad practice, there are a lot of instances of very good practice. We should not miss that in the discussion about where things are not going as well as they should be.

Contraception has been free for everyone and is readily available in the community from GPs, family planning clinics and abortion providers, but there are clearly barriers. Why are so many young women and men not using it? A number of factors can lead to risk-taking behaviour, such as sexual violence, alcohol, lack of contraception awareness and self-esteem. We need to use simple, effective messages about safe sex, sexually transmitted infections, condom use and contraception. We need to ensure that young people receive high quality education on relationships and sex and we need to tackle those issues in a holistic and effective way. We need to ensure that young people are equipped to make the choices and the sometimes challenging decisions that they face in their lives. Those decisions are increasingly challenging in this day and age.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

Those thoughts from the Minister are all excellent, but it is my understanding that before the general election the now Prime Minister promised Government time so that the House could have an opportunity to have a free vote on legislation to change, for example, the upper limit. Will the Minister tell the House tonight whether the Government are still committed to providing time and, if so, when?

[Anne Milton]

I thank the hon. Gentleman for his question. Others in this House might know more about parliamentary procedure than I do, but I understand that abortion is a matter that is usually raised by Back Benchers. He may look bemused, but that is what I have been told. It is usually raised by Back Benchers and the Government do not normally take a view on it. It is an ethical decision and there are usually free votes on it—I have witnessed them myself.

Young women and men need to think about contraception before having sex. People have busy lifestyles—and, in some instances, very chaotic lifestyles—and there are barriers to accessing contraception. However, with long-acting reversible contraceptives there are ways to prevent unwanted pregnancy for everyone, whatever their lifestyle. We need young women and men to be equipped with the information and knowledge to look after their physical, mental and sexual health so they are not put in this position in the first place.

Some £11.5 million has been invested this year and the sexual health charities Brook and the Family Planning Association, with funding from Government, have developed a new web-based contraception decision tool to help people to choose the best contraception for them. Launched on 14 July, the “My Contraception” tool asks users a range of questions about their health, lifestyle and contraceptive preferences and recommends a contraceptive method based on the results.

The Government’s “Sex. Worth talking about” national campaign has been quite well received and early indications suggest that it has prompted positive action. Local areas will now be able to use the “Sex. Worth talking about” campaign resources to support their local work. That is a development that I am sure we will all welcome. There are also pages on the NHS Choices website with a huge amount of information and a helpline for confidential advice.

Some advances have been made to ensure that women are able to have safe, legal abortions, but we need to stop the tide of unwanted pregnancies. That is the position that we want to be in. That will take an effort on a number of fronts, and later this year we will publish our White Paper on public health, which will set out our approach in a great deal more detail.

My hon. Friend the Member for Mid Bedfordshire rightly points out that a woman faced with an unwanted pregnancy is extremely vulnerable. She also rightly points out that the consequences of abortion can be traumatic and far reaching. I am pleased that my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) raised the issue of fathers, who are often forgotten in relation to this subject but who should not be forgotten in legislation and in the mechanisms we put in place to ensure that we not only prevent unwanted pregnancies but deal with their consequences.

I shall be very grateful for the continued support of my hon. Friends in making sure that we get the very best services available for women at this critical time. Anecdotal and individual Members’ experiences are vital to ensuring that we get those services right. Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.

Question put and agreed to.

Contaminated Blood and Blood Products

Debate between Anne Milton and Thomas Docherty

Thursday 14th October 2010 Commons Chamber

[Anne Milton]

I thank the hon. Gentleman. I will admit to a certain amount of ignorance. I do not know what I can do, but I will do everything I can within what I am allowed to do. It is important to say that I am very keen to get on with this. The danger with an inquiry that extends its remit is that it drags on and on, and this issue has dragged on for more than 25 years.

No fault has ever been found here in the UK—a fact that has been tested in the courts. In 1988, a group of haemophilia patients and their families sued the Government of the day. They settled their case outside court, midway through the proceedings, as their solicitors had advised that they had very limited chance of success.

Whatever happened all those years ago does not change the facts of today. In the United Kingdom, decisions over tax and spend are made here in this Parliament. The decisions of the Irish Parliament, like those of any other national Parliament, have no authority here in the UK. The debate on contaminated blood products has continued for many years, and I would like to close my remarks by again offering my sympathy and expressing my deep regret at the events, and by saying how sorry I am that this ever happened.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

Does the Minister accept that the nervousness that follows her logic of not looking at other countries means that on a whole range of compensation issues the Government are now simply saying, “We are washing our hands of our responsibilities”?

[Anne Milton]

I am not washing my hands of any responsibility—I am taking full responsibility. I am determined to see this review completed by Christmas within the terms that I have laid out.

My right hon. Friend the Member for Charnwood (Mr Dorrell) summed up the implications of voting for the motion more eloquently than I ever can. We cannot commit to aligning our compensation payments to those made in Ireland, and we cannot support the motion.

This debate has been useful in two ways. It has given hon. Members a chance finally to let the depths of this tragedy be heard. It is absolutely dreadful that no time has been found to debate this issue on the Floor of the House before. Secondly, it has enabled us to discuss how we can move forward. I want everyone, including hon. Members and campaigners, to be able to make their views known and know that they will be taken into account. I want the review to be dealt with openly and honestly, with clarity, without party politics, with humility and with empathy.

I cannot turn the clock back and change events, but I will do what I can in the time I am in office to bring some closure to those affected.