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Northern Ireland (Executive Formation etc) Act 2019

Part of the debate – in the House of Commons at 11:02 pm on 28th October 2019.

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Photo of Karin Smyth Karin Smyth Labour, Bristol South 11:02 pm, 28th October 2019

There is a large degree of agreement with much of what the Secretary of State has said, as he has already intimated. He was busy over the summer meeting individual party leaders, and it would be helpful to know when he expects all parties to come together for a plenary to take forward Executive formation, because there has not been one since last July. He may be able to come back to us on that.

On medical places provision, I also visited the campus at Derry/Londonderry. Developing medical training places locally is hugely important to help with the situation in Northern Ireland. It would be helpful for the House to understand where the real hold up is to and start working on an assessment to progress matters. There is a clear need and a political agreement on the ground to try to make that happen.

In the short time available, I will concentrate my comments on abortion law reform. The report contains a heading, “Provision of termination of pregnancy services after the interim period”, which I expected to outline how the new service would look after March, but it actually talks about—we hear this consistently from the Government—a medically based legal framework. I would like the Secretary of State to be able to explain exactly what that medically based legal framework is and why it is required.

This is already a highly regulated area of health service practice. In addition to the Criminal Justice Act (Northern Ireland) 1945, regulations apply in a number of areas. First, consent must be given by a woman or else a termination would be criminal—all medical procedures rely on the principle of consent. Secondly, England and Wales have the Care Quality Commission, and Northern Ireland has the Regulation and Quality Improvement Authority, which registers and inspects hospitals, GPs and independent providers. It has the power to suspend or cancel registrations, prosecute, set out special measures and undertake inspections of facilities.

Thirdly, clinicians are governed by their own professional standards. They have to ensure that they have fitness to practise, they have a duty of care, there are clear complaints and litigation processes, and both the General Medical Council and Nursing and Midwifery Council service standards must be adhered to.

Finally, the National Institute for Health and Care Excellence is responsible for developing clinically appropriate treatment regimes for all areas of medical care and controls on the sale and supply of medicine.

I am not a lawyer, but before entering this place I spent most of my professional career over the last 25 years in the NHS, planning, commissioning and monitoring healthcare services. I accept that there are issues to be clarified in the new regime, particularly around conscientious objection and ensuring that women, including doctors and nurses, who seek an abortion service are perhaps offered services away from home for the purposes of anonymity, which might be an issue, particularly in rural areas. I accept that, but the Secretary of State needs to clear about what exactly he considers to be the legal gaps and to consider how, in the absence of an Executive, women in Northern Ireland can be assured that a high-quality medical service is being planned, how it will be delivered and how it will be monitored.

New healthcare services are introduced all the time across the UK. Indeed, in my professional experience, doctors are always complaining that managers stop them developing new services. The basic process for planning and introducing a new service is fairly straightforward. It has patients and the public at its core. There needs to be an assessment of need in the given population, a projection of the numbers requiring the service, with the case mix and the requirements for tiers of specialism. There needs to be an understanding of what the referral process is, and the planners need to look at the workforce and facilities requirements.

In England, we learned the lesson a long time ago that women should not be seen within a general obstetrics and gynaecology service, and the service for terminations is largely carried out by specialist providers. We need to know whether the Department of Health in Northern Ireland is undertaking that needs assessment. What is the estimation of numbers? What are the expected workforce and facilities requirements? How and where are women to access the service? What is the development of a referral process for women requiring either a medical or a surgical intervention?

Additionally, health is one of the six original core areas of north-south co-operation on the island of Ireland, as part of strand two of the Good Friday/Belfast agreement. Following the mapping exercise that recently took place as part of the Brexit process, a report was finally published in June, after some time of asking. We learn from that document that the exercise recognised that

“the size, population and geography of the island of Ireland mean that economies of scale for certain specialised services only exist at an all-island level or, for certain regions, on the basis of North-South cooperation. This means that, in a number of fields, in the absence of North-South cooperation, patients and health services would be directly affected. North-South cooperation and EU frameworks also support the continuity of care and of supply of health products, such as medicines and medical devices.”

This is an important area, so have the Government or health officials in Northern Ireland started talks with their Irish counterparts and counterparts in Britain about how women access highly specialised services?

In the last two years, as a member of the British-Irish Parliamentary Assembly’s committee D, chaired by Lord Dubs, I have participated in evidence-taking on abortion services across the jurisdictions of Britain and Ireland. We have taken evidence in Liverpool, London, Belfast and Dublin. I commend our report, which we have just produced, to the House. We considered a number of cross-jurisdictional issues, including the impact of changes to the law in Ireland, the cost of travel, the impact on women with low economic resources, and the treatment of foetal remains and the particularly traumatic and unpredictable process that women currently have to go through. There is a lack of specialised skills across all jurisdictions, particularly for women beyond 18 weeks, and an issue with the online availability of abortion pills.

These issues are testing health services across Britain and Ireland. We can learn lessons from each other, and we need co-operation. There is a need for designated centres across Britain and Ireland. We need an assurance that the Government are progressing and giving clear guidance to officials in the Northern Ireland Office and the Department of Health on the work required to deliver this service.

In conclusion, it is not clear to us what additional legal requirements are needed or for what purpose. Will the Secretary of State say, either tonight on the record or by committing to bringing this forward in the next report, what legal gaps the Government think need to be filled? Will he confirm that the Northern Ireland Office and Department of Health are now planning the introduction of this new service along the lines I have outlined: by undertaking a needs assessment, an estimation of the demand and case mix, and through the provision of staff, facilities and a clear referral process for women to meet their health needs? Will he outline what discussions his officials will be having with their counterparts across Britain and in Ireland about access and referral pathways to specialised services? Will he commit to bringing back to this House, in this report, or by a ministerial statement, a clear account of how the devolved Department of Health is developing this service in a way that allows some public scrutiny for the women of Northern Ireland?