I am extremely grateful to you, Mr Speaker, for granting this Adjournment debate. Three months ago, during our debates on the Health and Social Care Bill, an amendment upholding a notion supported by 78% of the British public, that
“a woman should have a right to independent counselling when considering having an abortion, from a source that has no financial interest in her decision” was put to the vote. It was voted down by a majority of three to one. I know this all too well because I intervened in the debate to say why I hoped it would not go to a Division. It felt misplaced in the legislation and followed a fractious debate that had been conducted in the papers and the media. It descended, as all such debates seem to, into a political bun fight. Indeed, one of the few voices of moderation—hon. Members might be surprised to hear me say this—was the Under-Secretary of State for Health, Anne Milton, who is in her place tonight.
The Government are rightly engaging in a consultation process to see how best to improve pregnancy counselling services. It is in that context that I sought this Adjournment debate. I hope that we can show, as a House, that we have the maturity to ask a simple question without descending into accusations either of betrayal or of compromise. The question we must ask is this: do the present arrangements for pregnancy counselling, when a woman is deciding whether to undergo a termination procedure or to make arrangements for seeing her pregnancy through, serve us well?
I should like to quote a few women who have spoken about their experiences of the pregnancy counselling system as it is currently constituted. All these women received taxpayer-funded counselling; they really are the most important voices we could hear from this evening. A woman called Jennie had a bad experience. She said,
“I felt this counsellor was disinterested. I actually told her to pay attention because this was important to me that I had this counselling. It was like she was thinking about her shopping and I was just choosing a handbag.”
“I felt irritated with the counsellor because she presented my abortion options like it was a sweet shop; ‘So what would you prefer? The pills that will do this, this and this or you could have a surgical procedure.’ I was so angry; I just told her I didn’t care.”
Other women have reported that they felt pregnancy option counselling simply was not made available to them. A woman called Kerry said:
“They did not offer me counselling. I was crying and screaming as I went for the abortion but they still went through with it. I was pressurised by my boyfriend. It is the first thing I think about in the morning and the last thing at night.”
Patricia was not offered counselling either. She said:
“I was never given any options. When I took the second pill I was sent home to have the abortion. I have not stopped crying ever since.”
It is tempting to dismiss these experiences, but they are real. Any mature debate will, I hope, avoid the accusation that these women are in some way rewriting their own history. Surely we should do all we can as a society to ensure that women, regardless of their choice in such circumstances, do not have to live with regret, in many cases for the rest of their lives.
At the heart of the proposal that all women should access independent counselling where the source of that counselling does not have a financial interest in their decision is a concern about the current arrangements. At present the only available taxpayer- funded pregnancy counselling is given by those working for abortion providers. Some have suggested that this means that counsellors will act unprofessionally, in a directive fashion. I do not suggest that, but I do have a concern.
When a pregnancy counsellor also works for an organisation that provides abortions, there is an underlying direction of travel. The expectation, for both the organisation and the woman accessing the service, is that the normal process will conclude in the termination of a pregnancy.
Given that the law gives a woman the right to choose, does the hon. Gentleman agree that a woman should also have the right to choose from where she gets her counselling? I have a wonderful lady in my constituency, Sarah Richards, who receives no funding for the women who come to her. She does not badger them in any direction. Would the hon. Gentleman like to see a woman such as Sarah Richards who provides such a service receiving the same payment as the British Pregnancy Advisory Service receives for the women it counsels?
The hon. Gentleman makes an extremely good point about the experiences in his constituency. I will go on to talk about the system that I think might be able to facilitate something along those lines and address some of the concerns that, quite understandably, many people will have when they hear about those who are currently outside the system coming in as well.
It is reasonable to expect that women are offered, should they want it, counselling that does not have a connection and an underlying association with only one outcome.
My hon. Friend is making a very thoughtful case. Does he agree that we particularly want to avoid late terminations? They are stressful for women and they are obviously a cause of great concern. How would he be sure that directing women to sources of counselling outwith abortion providers would not cause delay?
My hon. Friend makes an extremely good point. Where terminations are to occur, they should happen early. There is a concern that women who desire the kind of context in which they can make their own decision are provided for as well. There will always have to be a balance in any system, but there is an inherent risk in the system as it is currently constituted that women are not able to access that counselling.
It is reasonable that independent pregnancy counselling should be made available to all women who are considering their options. It might surprise the House to know that there is no legal guarantee that such counselling is available.
I commend the hon. Gentleman for introducing this important debate. Does he also agree that where such counselling is offered, it should be provided by counsellors who have specialist training and experience in advising those who are in the situation he describes?
The hon. Lady makes an extremely good point. I agree, and I will go on to say a few words about some of the criteria that we should look for in people providing such counselling in future.
I believe it is perfectly reasonable, in a debate as complex and fractious as this, to suggest that given the issues we have talked about, the most sensible thing the Government could do is take out of the equation the financial link between counselling and the procedure. I accept that there are opinions in all parts of the House, but one simple principle to enact—and one potentially complex thing to do—would be to take the financial link out of the process. Many would see it as wrong that pregnancy counselling is currently monopolised by those who are pro-choice. There is an imbalance in the system which means that, by and large, counselling is provided only by private abortion clinics. I encourage hon. Members, whatever their perspective on the issue, to consider this simple question: can it really be right that the only taxpayer-funded pregnancy counselling available is currently given by those working for abortion providers?
Counselling in this context should always be non-directive, client-centred and universally available, and the right to it should be legally protected, but I do not believe that it should be subject to a duopoly, as it is at present. If a provider can produce genuinely client-centred and non-directive counselling that is free from a financial link to any given procedure, I believe that the NHS should fund it. There are more than two such providers in the UK today.
In that light, I very much welcome the commitment that the Minister gave the House in September. She said:
“Whether women want to take up the offer of independent counselling will be a matter for them, but we are clear that the offer should be made.”—[Hansard, 7 September 2011; Vol. 532, c. 384.]
She also spoke of the difficulty in defining what was meant by “independent” in this context. For some it simply means non-directive, but for others it means independence from finance or independence of the organisational structure from the abortion provider. As I understand it, her Department has not yet given any assurance that the offer of independent counselling would by definition mean counselling by persons or bodies without any kind of vested interest in abortion provision. I ask her to reflect on this and reiterate her commitment that women will be offered independent counselling and that the way to ensure that is by creating a regulatory framework that recognises the provision of alternative sources of pregnancy counselling to those offered by the big two.
In this country we have more than 40,000 trained counsellors who are members of either the British Association for Counselling and Psychotherapy or the UK Council for Psychotherapy. I hope that the Department will liaise with both organisations and the Royal College of Psychiatrists in developing an entirely new approach to how pregnancy counselling is provided in this country.
I know I speak for many, both in the Chamber and outside, when I say that my preference would be for abortion clinics not to be provided in pregnancy options counselling, ensuring that every woman seeking such counselling would know that there is no financial relationship between counselling and the provision of a termination. However, I accept the Government’s position that the right way forward on this issue is through consultation that allows all parties to express their views. It seems entirely practical and plausible for the Government, using the resources currently available, to develop a system in which every woman considering her pregnancy is offered counselling, should she wish to have it.
Non-directive pregnancy options counsellors, who are excluded from the present state settlement, can offer practical advice and help for women who choose to take their pregnancy to full term and often an ongoing support relationship. The focus of existing providers, understandably, is whether to abort or not. Just as choices are wider than simply whether or not to have an abortion, so counselling should give recognition to and advice on adoption and fostering when a woman considers continuing with her pregnancy.
Let me turn to the inevitable charge that allowing counsellors who are pro-life in their personal lives into the system would be inherently damaging to women. It starts with an assumption that the present system is both neutral and independent and hinges on a prejudice about those who hold such convictions. Allow me humbly to disagree with this notion. First, if the debate this autumn taught us anything, it is that no one is neutral. On an issue of conscience, right-minded and well-meaning people will rightly disagree and end up on different sides of the debate, but they will hold a position of conscience that they feel strongly about, hence my suggestion that we do what we can do now, hence my call to break the financial link between counselling and the termination procedure, and hence my desire to ensure that there is no nagging doubt at the back of any woman’s mind about who is looking out for their interests.
Secondly, there is an assumption that people cannot park their personal convictions at the door. Every counsellor knows that pressure in any direction is counter-productive for a woman who wants to continue her pregnancy but needs the space to reach that conclusion herself. In a new system, every counsellor should know that, whether they are personally pro-choice or pro-life, any moves that depart from non-directive principles should endanger their ability to do such work in future.
Equally, I hope that being pro-choice would mean being pro-all-the-choices available to women and that some providers are more expert at providing additional choices to those currently available and funded within the present system. That is why I hope that providers who, as many Members have mentioned, are doing amazing work to support women who would otherwise have felt no option but to undergo an abortion will be welcomed into our present system.
As a House, we have always had the ability to bridge divides, overcome prejudices we see in one another and together find a better arrangement for those we are here to serve. I feel certain that there are women who are let down by the current arrangements. The right response for us is to come together in a spirit of respect, excluding no one or their views. The ongoing consultation by the Government is an opportunity for us to do so, and I hope that we will not be found lacking.
I thank 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 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.
I commend my hon. Friend 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?
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.
I congratulate my hon. Friend on the stand that she is taking, even though some of her statistics have slightly mystified me. Before she completes her speech, will she tell the House roughly when, after the consultation next January or February, she believes we will come to a new arrangement for abortion counselling?
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.
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.