My Lords, first, I want to follow up on a point I made yesterday and compliment the noble Lord, Lord Bethell, and through him the Government. I asked about MOTs; this morning, there was an announcement of a six-month extension, so thank you.
We have already heard some accounts of the terribly difficult situations that people around the country are in. I will begin with another, that of a woman in Lincolnshire with an autoimmune disease. Under the Government’s recommendations, for her health and well-being and to protect our NHS resources, she should remain at home and self-isolate for 12 weeks. However, she needs an abortion. She also has at home a two year-old with a heart condition—another reason why she should not leave the house—but she must leave the house and go to a clinic or approved place to take the first of the pills for an early medical abortion under our current law. I am sure that every Member of your Lordships’ House will agree that this is a terrible situation. It is also an utterly medically unnecessary situation.
Taking the pill at a clinic is not a medical necessity; the provision is in the 1967 Abortion Act—an Act that was passed 25 years before medical abortions were even introduced. In the next 13 weeks, based on the average figures, 44,000 women will have to travel to a clinic—to an approved place—to take that pill, which is utterly medically unnecessary. In countries such as the United States, Australia and Canada, it is possible for women to take both the pills necessary for an early medical abortion at home.
This amendment provides for—and I stress this—temporary modifications to the Abortion Act 1967. It provides for a woman to take both those pills at home, as happens in the countries I mentioned, and it removes the two-doctor rule whereby two doctors have to sign off on an abortion. Only a small number of doctors and health professionals provide these services. We have discussed time and again in your Lordships’ House just how much pressure our medical professionals and NHS services are under and how precious a resource those doctors are, most of whom do other services as well.
The amendment calls for allowing nurses and midwives, who are already professionally qualified and who do much of the work now, to certify these abortions to allow them to go ahead. One nurse, midwife or doctor would then report back to the Chief Medical Officer as usual. There are some points to stress about the general provisions of the Bill that perhaps we have not talked about very much. The Bill, and this amendment, would give the Government the power to switch provisions on and off as they wish. They can also do so regionally—again, we have not talked about this very much—or the nations can do so according to the needs of place and time. If, for example, there was a real problem with provision in the south-west, the Government could take a small-scale decision for a particular place and time to make sure that abortions are available for the people who need them.
The argument for having this provision—as with many such provisions—is that it is about protecting everybody. If 44,000 women have to make extra journeys, it means more chances for the coronavirus to spread. We would be playing into the virus’s hands. We have all heard, seen and have been using the slogan “Stay at home. Save lives”; this provision allows that to happen. We would be protecting our precious medical professionals. The people who are increasingly operating remotely need to be able to operate through telemedicine remotely. We would be protecting NHS resources, which we know there is already enormous pressure on. If people are not able to secure an early medical abortion, they will seek surgical abortions, which will put much more pressure—absolutely unnecessary pressure—on the NHS.
I ask the Minister to accept and incorporate this amendment into the Bill. Doing that will not force the Government to do anything; it simply creates the possibility for the Government to act. As the noble Lord, Lord Adonis, who is not in his place, said, we will not be here for a very long time to make other legal changes. We would expect that to be the time of maximum pressure from the virus, so please can this temporary change be put in place to deal with this crisis?
My Lords, I have attached my name to this amendment, which has support on Benches across the House. In moving this amendment, the noble Baroness described exactly what this is: a power that the Government could and should take unto themselves in order to use it if necessary. Why do we think it might be necessary? “We” includes the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Faculty of Sexual and Reproductive Healthcare—all the providers and people within the health service who know this piece of work better than anybody else. Why do we need it? As of this morning, 25% of BPAS clinics are closed because they do not have the staff to open. That means things are becoming much more difficult for women. Yesterday, women in York needed to travel two miles to secure an earlier medical abortion. As of today, they will have to travel 40 miles.
Multiple NHS services are not providing. They have reduced staffing—we all know and understand that—and are having to reduce opening times. Some are not taking women unless they have a referral from a GP. Can noble Lords imagine what a GP’s day is like in current circumstances? There has been a drastic decline in the capacity to provide surgical abortions, because operating theatres are being used for ICU and urgent cases. Women with serious underlying medical conditions are told to isolate for 12 weeks, yet, if we do not change this, 4,000 will have to make weekly journeys—increasingly long journeys in some parts of the country. This morning France introduced telemedical care for abortion to deal with the pandemic. Telemedical care just for this purpose is supported by all the organisations I mentioned earlier. Remote provision is ruled safe by the World Health Organization.
In this Bill, some of us have conceded points that we think to be fundamentally important to our way of life. For example, we have agreed that people will be incarcerated for mental health reasons on the say-so of just one doctor. I will not rehearse the discussion we had yesterday, but time after time there were speeches in which Members of the House said, “In normal circumstances I cannot do that, but I have to”.
This is the situation in week three. Imagine what the situation will be like in week seven when we are back—if Parliament comes back. This is necessary and urgent. It not only affects the lives of the women concerned but has a huge impact on NHS staff and the rest of society. I therefore strongly urge the Government to accept this proposal.
My Lords, I attempted to put my name to this amendment. For some reason, presumably because the Public Bill Office staff are all working from home, it did not quite get through. The Government need to give this very serious consideration indeed.
My Lords, I completely recognise the good intentions of this amendment and the desire to protect women in an awkward situation at a difficult time. I also recognise the strong stakeholder views given to me by the royal college, Marie Stopes and others, but it is the Government’s priority to ensure that women who require abortion services should have safe, high-quality care and that abortions should be performed under the legal framework already set out by the Abortion Act.
It is vital that everyone, regardless of their views on abortion, be assured that this Bill’s provisions work alongside existing priorities of legislation, including abortion legislation. As I have described a number of times from this Dispatch Box, the powers in this Bill are solely and entirely to meet the needs of tackling this current pandemic. It is in that spirit that the Bill has moved so quickly through the House and that we have had such strong multi-party support for it.
The safety of women remains our priority, but it is vital that appropriate checks and balances remain in place regarding abortion services, even while we are managing a very difficult situation such as Covid-19. We have worked hard with abortion providers, including the Royal College of Obstetricians, and listened to their concerns, but there are long-established arrangements in place for doctors to certify and perform abortions, and they are there for good reason. We do not think that it is right that midwives and nurses are suddenly expected to take on expanded roles without prior consultation, proper training or guidance in place.
The coronavirus outbreak is a global issue. We are not the only country having to make difficult and uncomfortable changes. All over the world, clinicians and service users are coming to terms with extremely difficult workloads and workarounds to normal procedures. We are doing an enormous amount to help the NHS cope. We are doing this to protect life and to protect the NHS, but we expect doctors to work flexibly during this time. That means that certification can still take place in a timely way. It should not delay women receiving treatment. There is no statutory requirement for either doctor to have seen or examined the woman, as I described at Second Reading yesterday. Assessment can take place via telemedicine, webcam or telephone. Guidance from my department is crystal clear about that. The doctor can also rely on information gathered from other members of their multidisciplinary team in reaching a good-faith opinion. However, we do not agree that women should be able to take both treatments for medical abortion at home. We believe that it is an essential safeguard that a woman attends a clinic, to ensure that she has an opportunity to be seen alone and to ensure that there are no issues.
Do we really want to support an amendment that could remove the only opportunity many women have, often at a most vulnerable stage, to speak confidentially and one-to-one with a doctor about their concerns on abortion and about what the alternatives might be? The bottom line is that, if there is an abusive relationship and no legal requirement for a doctor’s involvement, it is far more likely that a vulnerable woman could be pressured into have an abortion by an abusive partner.
We have been clear that measures included in this Bill should have the widespread support of the House. While I recognise that this amendment has some profound support, that the testimony of the noble Baroness, Lady Bennett, was moving and heartfelt, and that the story of her witness from Lincolnshire was an extremely moving one, there is no consensus on this amendment and the support is not widespread. Abortion is an issue on which many people have very strong beliefs. I have been petitioned heavily and persuasively on this point. This Bill is not the right vehicle for a fundamental change in the law. It is not right to rush through this type of change in a sensitive area such as abortion without adequate parliamentary scrutiny. For example, there has been widespread support for measures such as permitting cremations to proceed on the basis of only one medical certificate. We simply do not have the same widespread support to make similar recommendations on the certification of abortions. For that reason, I urge the noble Baroness to withdraw the amendment.
Can the Minister concede that we are tabling this amendment because of how the NHS and medical services are affected by the Bill. We are not asking for any change in the criteria for abortion. We are asking simply for the process of the administration of decision-making to change.
That is being done right across the whole of the health service. The Minister has explained that telemedicine is being rolled out at a surprising rate. I do not understand why an experienced clinician or a midwife cannot make the judgments that he was talking about via video. They see women all the time and they will be able to make the same judgments. I do not understand that. If the Government do not accept this proposal, I ask him to accept that they should at least be under an obligation to continue to meet very regularly with the Royal Colleges and the organisations involved in this situation day to day, and they should be willing to come back with the power to make this change under a separate piece of legislation—because if, in seven weeks’ time, there is a clear pattern of women being failed, we cannot let it continue.
I completely recognise that the noble Baroness’s intentions are totally and 100% benign. She has the interests of the women concerned at heart. That intention is completely clear to me and I utterly endorse it. Where there is a difference of opinion and where we have taken a huge amount of advice—we have worked with the scientific advice in the department —is in the fact that the changes being offered are a fundamental change to the way abortions are regulated and administered in this country. Those regulations and administration arrangements have been worked on for years and are subject to an enormous amount of consensus. Her point on monitoring the situation is exactly the one that the noble Baroness, Lady Watkins, made earlier. I commit the department to monitoring it. We will remain engaged with the Royal College of Obstetricians and Gynaecologists and other stakeholders. She is absolutely right that we can return to the subject with two-monthly reporting back, and it can be discussed in Parliament in the debates planned on a six-monthly basis.
My Lords, before I get to the procedural part I will refer the Minister to some of his own words. He referred to the Government’s desire to ensure that everyone should have safe, high-quality medical care. In this area in particular, given that the option has been given to provide alternatives, that is something that the Government will be judged against, and I hope that he will be able to live up to his promise. However, it is with a heavy heart that I beg leave to withdraw the amendment.
Amendment 6 withdrawn.
Clauses 85 to 88 agreed.
Clause 89: Expiry