Complications from Abortions (Annual Report) Bill [HL]

Baroness Merron Excerpts

2nd reading
Friday 13th December 2024 Lords Chamber

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

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.

Complications from Abortions (Annual Report) Bill [HL]

Baroness Merron Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

[Lord Sandhurst (Con)]

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)]

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.

--- Later in debate ---

[Lord Moylan (Con)]

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)]

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.

Clause 1 agreed.