Complications from Abortions (Annual Report) Bill [HL]

Lord Moylan Excerpts

2nd reading
Friday 13th December 2024 Lords Chamber

Moved by

[Lord Moylan]

That the Bill be now read a second time.

[Lord Moylan (Con)]

My Lords, abortion is a generally safe procedure for women. It is not my purpose in bringing this Bill forward to dispute that. Rather, the question this Bill raises is: how safe is it? To know that, we need statistics that reflect real experience.

I start by drawing attention to the excellent brief that the Library has produced. This is a debate about statistics and statistical methodology, and I do not think the complexities involved could have been set out with greater clarity than they are in this brief.

The Library brief also includes at the end certain objections to the Bill expressed by the British Pregnancy Advisory Service—although it has not in fact contacted me. The first is that the Bill exceptionalises abortion. Strangely, I think that objection gives us a way into this debate. Abortion is indeed exceptional in that it is the only common procedure that is made available by the NHS but in the great majority of cases—about 80%—is provided by independent clinics, such as the charities BPAS and Marie Stopes, although there are other smaller providers as well. That is where the statistical issues start.

Independent abortion providers provide information on terminations, including on complications arising, to the Chief Medical Officer. This is known as the abortion notification system, or ANS. It covers not only the independent sector but also the 20% of terminations carried out in an NHS setting. In the case of independent providers, the complications it captures are principally those that arise within the clinic, since many women who experience a complication after discharge from the clinic—this is a key point—will present to their GP, to NHS 111 or to A&E at a hospital. These complications are not captured by the abortion notification system.

I should add that there is a legal obligation on the Department of Health and Social Care to monitor and publish statistics on abortion, and it uses the abortion notification system for this purpose. There is an annual report published. The published rate of complications is low, generally about 1.2 to 1.4 per 1,000 in recent years, for which I have the numbers. But until recently nobody has collated figures on the level of complications not captured by the ANS data, because the complications were not reported to the abortion provider but dealt with through the NHS directly.

Last year, the Office for Health Improvement and Disparities, which is a branch or an arm of the NHS, turned its hand to this task. In November 2023—very recently—it produced its report. I have a copy here and it is a fairly chunky report. The task was more challenging than one might have thought There were, of course, many of the usual statistical conundra of what to count and what not to count, whether the definitions in different datasets were the same and matched, and so forth. In fact, the first half of the report is a careful and thorough essay on the methodology used, which is an indispensable thing to provide since it was doing it for the first time. The report focused entirely on incidents arising in a hospital setting using hospital episode statistics—I am going to use the expression HES from now on—as distinct from ANS; these are the two sets of data that we are dealing with. The report used the hospital episode statistic statistics and, importantly, did not include incomplete abortions that were not accompanied by a further complication.

There is an important argumentative point there, if I may just put some parenthesis around the next section. There is an important argumentative point between gynaecologists who would say that an incomplete abortion that was later completed was a successful abortion and others who would say that an incomplete abortion that was later completed was an unsuccessful abortion that was put right. Whether you count it as a complication or not raises issues of a definitional character between gynaecologists. The figures produced by the report did not include incomplete abortions that involved no further complication, although it did count them.

The report broke the complication rate down by age, showing what I think is generally accepted—that it is somewhat higher for older women—and by type, for example, haemorrhage, which is the most common complication, sepsis, cervical tear and so forth. The report’s headline finding was that the complication rate, when you take all the data together, was between 3.5 and 4.4 per 1,000 in the period 2017 to 2021, depending on the year, somewhat higher than the ANS data alone, and, I understand, statistically significant. However, this rose significantly to about 17, 18 or 19 per 1,000 if incomplete abortions without further complication were included.

The importance and relevance of this information is all the more significant when one considers changes in the way in which terminations are administered. Of course, a surgical abortion is now a relative rarity. Currently, about 85% of abortions are medically induced—that is, by taking a sequence of pills. In 2012, only 48% of abortions were medically induced; as I say, it is now 85%. These terminations frequently take place at home. Since the Covid pandemic, it is possible for a woman to obtain the medication from an abortion provider without an initial in-person interview or examination. What this shows is that the abortion landscape is shifting quite rapidly. Clinicians need to have available the most robust data about complications, indeed as women do for the purpose of informed consent. It is unfortunate, therefore, that it appears that there are no plans for the OHID to continue to collect the valuable data contained in its report of November 2023. My Bill would place an obligation on the Government to do so.

Turning to the Bill briefly, I note that Clause 1 does a number of things. It requires the Secretary of State to publish an annual report on complications. It states that the purpose is to inform policy and safe practice. It requires the inclusion of data from both the ANS and the hospital episode statistics. It specifies that the report must cover the same areas of information as the 2023 report. It gives the Secretary of State power to add further information that he or she sees fit to include, and it states that the first report must appear within a year.

Clause 2 covers territorial scope and commencement. In effect, the Bill applies to England. There is no other clause.

Before I sit down, perhaps I may deal briefly with some objections. First, I return to the comments of the British Pregnancy Advisory Service. I dealt with its claim that the Bill “exceptionalises” abortion. Abortion is exceptional; it is a very unusual way of providing a health service in this country. Its other comments seem to me to be rather weak. I think the key point is that it too agrees that

“further work needs to be done on collection and analysis of large datasets relating to women’s reproductive health”.

Nobody really defends the existing ANS statistical sets on their own as giving a realistic picture. BPAS also claims that there are better ways of deal with the problem than this Bill. That may well be true, but it does not suggest what they are.

I shall mention one further objection, and then I shall sit down. It may be said that an Act of Parliament is a bit of a sledgehammer to crack a nut if all one is looking for is an annual report. I see the force of that objection, while still supporting and sustaining my Bill, and if the Minister were to give a firm undertaking to do this without the bother of a statutory obligation, I should be well content. I beg to move.

--- Later in debate ---

[Baroness Sugg (Con)]

My Lords, the goal of improving women’s healthcare through better access to information, particularly regarding potential complications of medical procedures, is indeed important. Access to information enables individuals to make informed choices and allows healthcare professionals to provide safer, more effective services. However, while I support the overall goal, I have concerns about legislating for an annual report in this manner.

First, as we have heard, it is important to emphasise that abortion is a safe and effective medical procedure and, in fact, can be safer than continuing a pregnancy to term. While any medical procedure carries some risks, those associated with abortion are well managed and women are fully informed of them by healthcare professionals, ensuring that they are equipped to make the best decision for their own health. I agree that improving this data collection is crucial. As highlighted by the Royal College of Obstetricians and Gynaecologists, the lack of effective data has hindered innovation and improvement in women’s healthcare and, ultimately, the improvement of patient care. However, as we have heard, BPAS and the royal college have significant concerns about the Bill’s potential to exceptionalise and stigmatise abortion care.

Unlike other medical procedures, abortion would be singled out for mandatory complication reporting. No other procedure is subject to this. Doing so for abortion could create a false impression that it is uniquely dangerous. In reality, complications from abortion are rare—

[Lord Moylan (Con)]

It is already mandatory for complications from abortions to be reported. If that is exceptional, it is not made more so by this Bill. The question is from which data source one draws the reporting of those complications. They are reported and published every year by the department; this would not put a new requirement on abortion reporting.

--- Later in debate ---

[Lord Moylan (Con)]

My Lords, I am very grateful to all noble Lords who have spoken in this short debate. My noble friends Lord Frost and Lady Lawlor made important points about patient empowerment, but also about the improvement in medical care that can only follow from a better understanding of what is actually going wrong.

I am also partly grateful to the noble Baroness, Lady Miller of Chilthorne Domer, because she supported the principle that the data should be collated—she thought perhaps not by means of an Act of Parliament. I conceded that point in my opening remarks—there are other means of doing it—but she said that she thought the data should be collated.

I find myself less able to express gratitude to the noble Baroness, Lady Barker, who lives in a world that I simply do not recognise. I have not read the American book she referred to. She came dangerously close to suggesting that I was either in receipt of or being influenced by money for this purpose. That would be a contemptible thing to say, and I will happily give way if she indicates that she wishes to distance herself from any such implication.

My noble friend Lady Sugg said that the Bill required abortion complications to be reported for the first time, and that this would be different. It does not. Abortion complications, as the Minister said, are already reported. The question is whether the data is robust and the sources from which it is drawn. My noble friend also said that collecting data could compromise the privacy of patients. Well, of course it could, but it does not, because you collect it without compromising the privacy of patients. Nobody has suggested that the report produced in November 2023 remotely compromised the privacy of patients. All that the Bill does is require that this report continue to be produced on an annual basis.

The noble Lord, Lord Scriven, was massively keen to improve the quality of NHS data, but the moment he sees a report from the Office for Health Improvement and Disparities, which clearly improves the quality of data, he retreats into a sort of conspiracy theory.

[Lord Scriven (LD)]

If you are going to have end-to-end patient data, it needs to include A&E, GP, private, in-patient and out-patient. The statistical analysis that the Bill puts in place is a complete gap and does not give end-to-end patient data. Therefore, it becomes a totally ineffective use of statistics.

[Lord Moylan (Con)]

With respect, it is true that the report, which the noble Lord has obviously read carefully, does not include data from GPs or from 111. That would have been an onerous task and, as the Government have said, this was a first and experimental effort. This is an argument for going further and improving the collection of that data, not for giving up the attempt altogether and seeing it as a conspiracy, which is what the noble Lord appeared to do.

We are really all on one page about this—or at least he and I seem to be. What is so strange about the advocates of choice in this debate is that they are so defensive; they speak as if they are surrounded by conspiracy. I do not actually think they are. If I thought I was surrounded by conspiracy, I would want to live in a world of facts and not hide myself from them, which is what they seem to be doing. The proposal is that data produced by an arm of the NHS should continue to be produced, whether by statutory or administrative means. That is all it is.

I know that there are other things happening today, so I turn finally to the remarks of the Minister. I am grateful to her for being one of the few people to treat the Bill seriously and to look at what the words in it say. She wandered slightly from that into the worlds of strange contexts, but in fact a great deal of her speech was an echo of my speech. On the history and the factual and contextual issues here, we are largely agreed. I agree that the Bill exceptionalises abortion to some extent because, as I said, abortion is exceptional, in that its statistics are generated from different data sources, which is very different from the majority of NHS procedures that take place inside a hospital. I grant that the noble Lord, Lord Scriven, has a point that there are other exceptional cases. I did not say that abortion was unique; I said it was exceptional. There are differences between the two words, and he is right about some hip operations and so forth taking place in the private sector, where similar issues might arise as well.

The Minister says that there are different and other ways of collecting these statistics: non-statutory means. I conceded that point, too, in my opening remarks. What she did not say is that she would use a different, non-statutory means of collecting these statistics. I remind her that when she signs her letters, underneath her name it says: “Minister for Patient Safety and Women’s Health”.

We need better statistics on complications arising from abortions. I am disappointed that the Minister has not committed herself to that and agreed that, even if a Bill is not necessary for this purpose, she will set herself to do so. Sadly, she has not.

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

Complications from Abortions (Annual Report) Bill [HL]

Lord Moylan Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

I will not divide the Committee, but I will return to it on Report if the noble Lord, Lord Moylan, is not convinced by my argument that this is not a necessary Bill.

[Lord Moylan (Con)]

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)]

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.

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On the points that have been directed to the Government—the ones I am able to refer to—the noble Lords, Lord Moylan and Lord Sandhurst, and the noble Baroness, Lady Lawlor, asked about improving the design of the abortion notification system and whether it would be sensible to change the order to ensure a review by the Office for Statistics Regulation before investing in improvements. The department is engaging with digital experts and reviewing the design of the HSA4 form. We are also conducting research among system users in order to redesign the system. On the ordering of work, I confirm that the department is developing work with the OSR on improvements to the system that are required irrespective of the statistical impact. The reason for that is to improve the user experience for clinicians. However, the Bill is not required to make such an improvement.

[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.