23 March 2012
UK: Health Secretary launches shock wave of inspections on abortion clinics
The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports.
This action, which Lansley confirmed in a statement to Parliament today, 23 March (reproduced below), is allegedly a response to concerns that doctors are ‘pre-signing’ the HSA1 abortion forms. ‘The process of pre-signing certificates where the doctor does not know who the woman is for whom that certificate may be used in relation to that abortion is in itself illegal. I am not prepared to tolerate a failure to respect the law,’ Lansley said in a press statement yesterday.
He further stated: ‘The CQC has agreed to undertake unannounced inspections to identify the scale of this problem and we will set up a special team comprising of all the necessary regulators… to look at how we stamp out bad practice in abortion clinics.’
The BBC gives a more measured explanation of the law regarding the HSA1 form. ‘Except in emergencies, the law says two doctors must certify an abortion. However, there is no requirement for them to have actually seen the woman - only that they should have seen and assessed the necessary clinical information about her case, which could have been taken by another doctor or nurse.’
Lansley’s concern is that this ‘second signature’ is being provided before the doctor has reviewed the relevant notes. This is not the practice of most abortion providers, including British Pregnancy Advisory Service (BPAS). However, launching a wave of CQC inspections on the basis of forms potentially being pre-signed in some other clinics is a strange and heavy-handed action, for three reasons.
First, the second doctor’s signature has been long understood to be a legal, rather than a clinical, safeguard; arising from attempts in the 1960s to pass a controversial new law in the form of the Abortion Act. As such, many politicians – including Lansley himself – have questioned whether it is necessary to retain this cumbersome and clinically irrelevant requirement in the 21st century.
As the BBC explains, ‘The requirement for two doctors’ signatures was criticised as long ago as 2007, when a report by MPs on the Commons science and technology committee recommended it be removed because of the potential for abortions to be unnecessarily delayed.’ And Andrew Lansley himself, during the debate about the abortion law that took place in 2008, said:
‘If a woman needs an abortion in terms sanctioned by the Abortion Act 1967, it must surely be better for it to be an early, medical abortion than a later, surgical one. I therefore hope that the House will consider whether the requirement for two doctors to consent to an abortion being performed, and the restrictions on nurses providing medical abortions, need to be maintained.’
So it is strange indeed that the Health Secretary, busily engaged as he is in controversial reforms of the entire health service, should now view strict adherence to the ‘two doctors’ requirement as a sudden issue of major clinical concern. His quote in yesterday’s press statement could not be more different from the temperate approach that he took four years ago. On 22 March 2012, Lansley argued:
‘I am shocked and appalled to learn that some clinics – which look after women in what are often difficult circumstances – may be allowing doctors to pre-sign abortion certificates. This is contrary to the spirit of the Abortion Act. The rules in the Abortion Act are there for a reason - to ensure there are safeguards for women before an abortion can be carried out.’
The second peculiarity of this shock wave of inspections is that the ‘evidence’ upon which they have been launched seems remarkably thin. It seems to have come out of police investigations launched on the back on the Daily Telegraph’s investigation into ‘sex selection’ abortions last month, which itself found little evidence that such abortions were carried out.
There may be more basis Lansley’s concerns than a flimsy newspaper investigation – but we do not know. And this is the third and most striking peculiarity of today’s Parliamentary statement: that the media were briefed about it before any of the clinics whose work it might concern.
Ann Furedi, chief executive of BPAS, said: ‘Abortion doctors provide an important service to women who are often in difficult circumstances. Their work is already intensely scrutinised, with clinics regularly inspected by the CQC.
‘Mr Lansley says he is shocked and appalled by the practices he has uncovered. BPAS is shocked and appalled that Mr Lansley has found it necessary to inform journalists of alleged breaches of the abortion law before he has informed those responsible for providing the services that have been investigated, and before the investigation is concluded.’
WRITTEN MINISTERIAL STATEMENT
DEPARTMENT OF HEALTH
Enforcement of the Abortion Act 1967
Friday 23 March 2012
The Secretary of State for Health (Mr Andrew Lansley):
‘There have recently been a number of serious allegations involving potential breaches of the Abortion Act 1967. The Metropolitan Police, Greater Manchester Police and the West Midlands Police, the Care Quality Commission (CQC), the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) are investigating the allegations into sex-selection at a number of abortion services. The Chief Medical Officer has written to all abortion providers reminding them of their duties under the Abortion Act. The GMC interim orders panel has suspended or placed restrictions on the three doctors named in the press reports. Decisions on the registration and approval of the clinics are awaiting the investigations by the CQC and Department of Health officials into compliance with the Act and registration requirements.
‘Registration inspections by CQC in February also identified cases where doctors had signed the required certificate of the ground for the abortion (HSA1 forms) before the woman had been seen in the clinic. The Act requires two doctors to certify that at least one (and the same) ground for abortion exists in relation to a specific woman. The pre-signing of these forms is potentially a criminal offence and is being investigated by the CQC and the police and may lead to further referrals to the GMC or NMC.
‘In light of the serious nature of these allegations, CQC are this week conducting a series of unannounced inspections of all abortion providers. Any evidence of failure to comply with the Act and registration requirements will be investigated by CQC, the police and other regulatory bodies. I will consider withdrawing an independent abortion provider’s approval to conduct abortions if the requirements of the Act are not being met. Any provider’s registration to carry out termination of pregnancy may also be suspended or cancelled by the CQC. I will provide further final details of actions taken when the initial investigations are complete.
‘In addition, my officials will work with the CQC and other regulatory bodies to examine compliance with the Act and relevant statutory and professional requirements in order to inform the planned revision of the Procedures for the Approval of Independent Abortion Providers for consultation later this year.’
Abortion clinics get spot-checks. BBC News, 23 March 2012
Abortion forms being ‘pre-signed’. Guardian, 23 March 2012
How anti-abortionists are upping the ante. Abortion Review, 19 March 2012
Abortion for reason of sex: correcting some basic misunderstandings of the law. By Sally Sheldon, Professor of Medical Law at the University of Kent. Abortion Review, 1 March 2012