There are a set of moral, ethical, and medical issues around abortion.
[Also about use of Care Quality Commission staff for a politician's personal prejudices. More of that in the update below.]
The Telegraph does not appear to be interested in any of them, in its latest US-style article about “abortion clinics”.
First and most importantly: Is the person who is having the abortion being coerced in any way? It would be immoral and inethical for a doctor to perform an abortion on anyone unless she wants to have her pregnancy terminated.
But Andrew Lansley is apparently appalled at the headstrong notions some women have:
“I was appalled,” he said. “Because if it happens, it is pretty much people engaging in a culture of both ignoring the law and trying to give themselves the right to say that although Parliament may have said this, we believe in abortion on demand.”
Why, anyone would think it was forty years ago:
- Equal pay
- Equal education and job opportunities
- Free contraception and abortion on demand
- Free 24-hour nurseries
It’s important to remember that when Lansley and the Telegraph fulminate over “pre-signed forms”, what they object to is not that women might have been coerced into having the abortion: they’re cross because the clinics were apparently treating the rule that a woman must get consent from two doctors as an unimportant formality – the clinics were behaving as if what the woman herself wanted was the only thing that mattered.
Second, and almost as important: Is the abortion being carried out safely, by the best procedure for the health of the woman? Is the woman being given proper aftercare as needed? (Abortions, especially early abortions, are very safe medical procedures with almost no health risks when carried out legally and safely.)
There is no indication that the “one in five” clinics fingered by the Care Quality Commission were providing medically unsafe abortions. The objections the CQC have raised, according to the Telegraph, relate to this unacceptable level of allowing women to make their own decisions and failing to provide them with a sufficient level of “counselling and advice”. The Telegraph claims this shows “potential for abuse”.
Certainly I’d agree that if a woman feels she needs to talk through her decision to have an abortion with a licenced therapist either before or after, she should be able to do so. How much NHS funding, may we ask, is Lansley targetting to these clinics to ensure that every woman who wants to speak to a counsellor can do so without delay?
Dear Andrew Lansley, it may have escaped your notice, but as Health Secretary you’re where the buck stops if someone has a complaint about the health services in the UK. If there aren’t enough counsellors available so that some women who want to see a therapist can’t, well, that’s your responsibility, and maybe you shouldn’t have been spending so much damn time on selling the NHS off instead of running it to the benefit of the patients, hm?
Someone wrote on the front of Andrew Lansley’s constituency office “Hands off our NHS Tory Scum”. A spokeswoman for his office says “We think the attack must have happened overnight and we don’t have any idea who is responsible.” Well, quite, the field of suspects is large, isn’t it?
On the other hand, could be that there isn’t so much a shortage of therapists as a shortage of women who ask to speak to therapists. Prolifers in the US have consistently been shoving “advice” and “counselling” at women who don’t need or want it, as an excuse to delay the abortion or make it more expensive or more heartbreaking for the woman concerned. Given how appalled Lansley is at the idea that women can just “decide” they want to have an abortion…
In the US they need a campaign to get the message across: Trust Women
What do we need in the UK to convince Andrew Lansley that each pregnant woman is the only person who can be trusted with her own decision about abortion?
Update: Apparently Andrew Lansley got a bit ahead of himself getting all worked up about abortion on demand:
However, in spite of the strongly worded statement, it is unclear whether any evidence of illegality by clinic staff has been uncovered.
Abortion Rights understands that the order to immediately inspect all clinics came directly from the Secretary of State and that CQC staff were told to make the checks their highest priority. It appears that the Department of Health then contacted the Telegraph and the BBC to announce that it had important new revelations about abortion clinics.
So. Lansley worries some women in the UK might be getting effective abortion on demand, and therefore he launches a spot-check of one in five clinics that provide abortions – because it’s not like the CQC has been suffering any impact from the cuts.
[In 2010] the CQC had to write a desperate five-page letter to the Department of Health asking asking that they be considered for some additional funding. It boasts “we have delivered recurring savings of £44m”, but warned: “There are further ‘one off costs’ that will be necessary in 2010/11 in order for us to satisfy our obligations before CQC reaches ‘steady state’.
Savings in the CQC have been accompanied by a dramatic fall in the number of inspections that are undertaken. Figures released under the Freedom of Information Act show that there were only 5,331 inspections this year, compared to more than 48,000 inspections six years ago. In May, the CQC were criticised for failing to act on reports of abuse in Winterbourne View care home.
But obviously, policing a woman’s right to choose abortion is much more important to Andrew Lansley than setting decent standards of care in residential homes for elderly and disabled people.
Andrew Lansley bizarrely diverted NHS resources to do a sudden investigation of abortion clinics. This followed an article in the Telegraph. Of course. You have to remember that in many ways this is not a government, but a PR agency with fabulous offices. And as with all PR, you are at the mercy of public opinion as it shifts course. Sometimes it tugs you both ways, and you end up doing the splits, very painfully. As Abraham Lincoln almost said, you can please all of the people some of the time, you can please some of the people all of the time, but you can’t please … you know the rest.
Update, 12th July: £1m CQC abortion spotchecks find no evidence of unsafe care
Signing abortion paperwork in advance of a woman being assessed is not a practice bpas undertakes, and so CQC inspectors did not find doctors pre-signing forms at any of bpas’ 28 clinics. Pre-signing is a regulatory not a clinical issue: it is not a practice which puts women at risk or indicates that they are receiving substandard care, as the CQC makes clear. Bpas believes that the Secretary of State for Health’s decision to order immediate nationwide investigations at 249 providers, at a cost of £1m, was a disproportionate response to reports of this practice. Pre-signing forms was found at just 14 NHS sites. Rather than improving services for women, we are concerned that the primary consequence has been to create a climate of fear among abortion doctors – which is already impacting negatively on the women who need their help.
Under the Abortion Act 1967, two doctors signatures are required for an abortion. As the Secretary of State for Health is aware, many doctors sign forms legally without personally seeing the woman in question – whose assessment and support is often primarily provided by an experienced multi-disciplinary team. Pre-signing is a practice which may have been undertaken by doctors seeking to minimise the physical and emotional stress to a woman of having to wait any longer than necessary to end an unwanted pregnancy. If there were concerns about pre-signing, a more proportionate response would have been to inform all services that this was not an appropriate practice, rather than threatening doctors who were acting in good faith with prosecution.
bpas is aware that the CQC investigations and continual suggestions of criminal proceedings by the Department of Health have already had a very negative impact on the small numbers of doctors working in this vital yet stigmatised area of women’s healthcare, who are concerned they may be prosecuted over practices suddenly deemed unlawful. Doctors in some smaller services already struggled to find colleagues prepared to provide a second signature promptly, and the heightened scrutiny and uncertainty has made this even harder. The net result will be that women seeking abortion will find access to the services they need more difficult.
And the Care Quality Commission spent one million out of an already-slashed budget.