ABORTION (Hansard, 21 October 1975)

§ The Secretary of State for Social Services (Mrs. Barbara Castle)
With permission, Mr. Speaker, I should like to make, in association with my right hon. Friends the Secretaries of State for Scotland and Wales, a statement on abortion. Since March of this year a Select Committee has been considering the Abortion (Amendment) Bill of my hon. Friend the Member for Glasgow, Pollok (Mr. White). The Committee made nine recommendations in its Third Special Report to the House on 5th August, most of which follow up proposals made last year by the Lane Committee on the Working of the Abortion Act. I am glad to tell the House that the Government accept in principle all the Select Committee's recommendations.
My intentions, announced earlier this year, to strengthen the safeguards which apply to abortion in the private sector are similar to those recommended by the Select Committee. Action has already been taken following consultation with the medical profession with a view to requiring private nursing homes which concentrate on abortion to give me an assurance concerning the total fees charged to patients. Assurances have also been sought from all approved nursing homes about financial arrangements with referral agencies. Only those private nursing homes with adequate facilities will be authorised to carry out terminations of pregnancy after the twentieth week.
I have also written to those nursing homes which concentrate on abortion asking for information on the number of foreign patients treated during the 18 245 months to 30th June 1975 and I shall be seeking such information from all approved nursing homes at quarterly intervals in future. I am reviewing the arrangements which are made by the nursing homes for the reception, counselling and after-care of foreign patients on the lines proposed by the Select Committee and I will require changes in these arrangements where necessary.
The Committee recommended that the Health Ministers should produce a list of approved bureaux and refuse to approve clinics which accepted patients from unlisted bureaux. We are proposing to implement this change shortly, and application forms have been issued to bureaux and agencies. I am, moreover, concerned to ensure that adequate counselling facilities are available for all women who indicate that their pregnancies are unwanted, and a draft paper as proposed by the Select Committee giving guidance on counselling will be circulated for consultation to bodies representing the medical, nursing and social work professions.
In the National Health Service the Select Committee's recommendation that terminations after the twentieth week of pregnancy should be carried out only in hospitals possessing appropriate facilities, including resuscitation equipment, have been accepted, and discussions have been held with regional medical officers who will be responsible for the implementation of the recommendations. I have issued a circular to health authorities on the report of the Peel Advisory Group on the Use of Fetuses and Fetal material for Research asking for the adoption of its recommended code of practice where not already in use and I put a similar requirement on private nursing homes.
Some of the other recommendations of the Select Committee will require amendment of the Abortion Regulations 1968. My Department is undertaking a study of the procedures and forms set out in the regulations as proposed by the Select Committee, and in the light of its report I shall be considering the whole question of the procedure for the certification and notification of abortions. Another recommendation which would require amending the regulations is to allow the disclosure to the General Medical Council of information taken from the notification to the Chief Medical Officers of the Health Departments. This recommenda- 246 tion is accepted, and the regulations will be amended to permit disclosure to the President of the General Medical Council at his request.
A further change in the regulations recommended by the Select Committee is designed to ensure that the doctors who certify that the condition of the Abortion Act are met in a particular case should examine the patient. The regulations will be amended to ensure that a question asking whether the patient has been seen and an examination has been carried out will be put on all forms.
I think the House will be glad to know that action is being or has already been taken on all the recommendations made by the Select Committee in its Third Report and on many of the major recommendations of the Lane Committee. I have issued guidance on day care systems to health authorities and hope to authorise day-care services in some private clinics with a record of high standards. The most important preventive action which the Government have taken is to introduce as part of the NHS a comprehensive family planning service which started to function fully this summer. I can only regret that this was not introduced a decade or more ago.
During the Second Reading of the Abortion (Amendment) Bill in February 1975, a commitment was given by the Government that if the Bill were withdrawn the Government would propose the establishment of a Select Committee to examine and report on the proposals contained in the Bill and would also propose its re-establishment for the 1975–76 Session if this were necessary. In the event, the House did not allow the Bill to be withdrawn but instead committed the Bill itself to a Select Committee. Under this procedure the Bill and the Select Committee lapse at the end of this Session. The Government feel that the House, in the light of the Committee's reports already published and of this statement, should be given an opportunity to decide whether the Select Committee should be re-established as the Committee itself has requested, and a motion will be tabled early in the next Session.

§ Mr. Norman Fowler
We welcome this statement. Is the right hon. Lady aware that there is a strong feeling on both sides of the House that the Select Committee should continue its work and that 247 that part of her statement will be particularly appreciated? Is the right hon. Lady also aware that there is very strong support both in this House and outside for any measures which will eliminate abuses?
I should like to take one further point from the statement. As the Secretary of State realises, many of us attach particular importance to the Select Committee's recommendation that every woman contemplating an abortion should receive proper advice on the dangers and the alternatives. Can the right hon. Lady give the House a little more detail on what she has in mind in this important new counselling procedure that she is proposing?

§ Mrs. Castle
On the re-establishment of the Select Committee, I think we all agree that it has done very useful work. The items now remaining for consideration enter into some of the basic points of controversy on which hon. Members will wish to consider whether the Select Committee could or could not produce useful advice to the House. Therefore, we propose to allow the House to decide whether it feels that the Select Committee's work should continue. As far as the Government are concerned, that will be on a free vote.
Regarding counselling, as I have said I shall be consulting organisations representing the medical, nursing and social work professions and a consultative group of regional health authority officers. We want to see that proper counselling is given in which the alternatives to abortion are made quite clear and to ensure that proper after-care, advice and counselling after a pregnancy has been terminated are provided.

§ Mr. James White
I congratulate my right hon. Friend on the speed with which she has moved on this matter. I should like her to know that many thousands of people throughout the country share my views. I am fed up telling people that there has been a great deal of dubiety about whether the Select Committee will meet again in the next Parliament. Again, the Government are keeping a pledge. This proposal will come before the House for us to carry on. What my right hon. Friend has already done will go a long way 248 to clearing out some of the "rackets" in the medical world.

§ Mrs. Castle
I am grateful to my hon. Friend. He is absolutely right that the action that we have taken or are taking following the Select Committee's recommendations will deal with the abuses which have alarmed hon. Members on both sides of the House in the past and will make some important and far-reaching changes in the situation. I repeat that the re-establishment of the Select Committee is a matter for the House itself to weigh up. There are many factors to be weighed up. I should like to feel that hon. Members will be free to follow their judgment and consciences on it.

§ Mrs. Knight
Before the right hon. Lady brings before the House her proposals for tightening up the Act, will she consider withdrawing at once the directive to hospital boards not to employ junior and freshly qualified obstetricians unless they undertake to carry out abortion operations, since this is a grave invasion of their freedom to operate?

§ Mrs. Castle
I am sure that the hon. Lady is suffering from a misunderstanding of the situation. There is no such directive. I shall be happy to send her a copy of the Chief Medical Officer's letter on this matter. We have made it quite clear that doctors with a conscientious objection to abortion are not being exluded from working in the National Health Service, but we have also pointed out that the NHS is under an obligation to provide an abortion service as laid down by Parliament. It may happen that in some areas consultants normally dealing with abortion cases do so on behalf of colleagues who have a conscientious objection. When one of those providing a service which Parliament has decided should be provided moves away, if the service is to be continued it will be essential to ensure that the means exist of continuing the facilities.
I should point out to the hon. Lady that the Chief Medical Officer has been notified of only nine appointments made since 1st March this year in obstetrics and gynaecology and anaesthetics where there was a specification of the need for a willingness to carry out abortions. Only nine such appointments have been 249 made out of a total of some 70 appointments which would normally be made in such a period. The ratio of nine appointments out of 70 still leaves an overwhelmingly large area for those with conscientious objections to continue to practise in the National Health Service.

§ Mr. Willey
Does my right hon. Friend realise that the members of the Select Committee will greatly appreciate her ready and prompt reaction to the recommendations that they were able to reach unanimously?

§ Mrs. Castle
I am grateful to my right hon. Friend, who has done an excellent job on the Committee, for his comments. I appreciate, too, the spirit in which the Opposition Front Bench has responded to my statement. It is important that we should cease to deal with these matters on a party basis.

§ Mr. Awdry
If the Select Committee is reconvened, will it consist of the members of the existing Select Committee?

§ Mrs. Castle
We think that this is a matter for the House. The motion will be considered by the House when the time comes.

§ Mr. Abse
Will my right hon. Friend be ready to acknowledge the thanks of a large number of people now that she has activated her Department, which has been so tardy in the past in dealing with abuses which are now revealed as being in existence and needing considerable attention?
The Select Committee, which has been able to reach unanimity on so many matters and to help my right hon. Friend, has expressed the opinion that there is a need for a Select Committee to be re-established to deal with matters such as conscientious objection and many other issues. If the Select Committee were not re-established, it would be regarded in the country as though once again an attempt was being made to sweep abuses and wrongs under the carpet.

§ Mrs. Castle
I am sorry that my hon. Friend has spoilt the harmony and atmosphere that was prevailing by that quite unfair allegation against my Department, because anyone who listened to the speech of my hon. Friend the Minister 250 of State during the Second Reading debate on the Bill would have realised that we were already proceeding to act against abuses of which we were aware. But that does not prevent me from paying a tribute to the work of the Select Committee for continuing, as it were, to round up the abuses still prevailing in the private sector. I pay a tribute to my hon. Friend's work in the Select Committee, but I shall not accept his indictment against my Department. As for the re-establishment of the Select Committee, I think that my hon. Friend's remarks were really appropriate to that debate.

§ Mr. Jessel
May I remind the right hon. Lady that in February the Abortion (Amendment) Bill was given a Second Reading by a large majority of 115 and that there is no evidence that the opinion of the House has changed substantially since then? Apart from the possibility of reconvening the Select Committee, what action does the right hon. Lady propose to take to give effect to the wishes of the House?

§ Mrs. Castle
I do not know what my statement has been about if it is not about the steps that we have taken, without any delay, to give effect to the recommendations of the Select Committee with regard to abuses of the abortion legislalation.
As for the support of the House for the continuance of the Select Committee, that is a matter that we shall discover when the motion is debated, because it could well be that some Members will feel that the action taken on the Third Report of the Select Committee is the answer to the anxieties that they had when they voted as they did on Second Reading.

§ Mrs. Renée Short
May I ask my right hon. Friend exactly what her statement about the number of foreign women coming into this country for abortion implies? Is she aware that, according to the figures given to me recently by her hon. Friend the Minister of State, it is clear that there has been a dramatic reduction in the number of foreign women coming to Britain because of the more liberal abortion laws in France and elsewhere? 251 Secondly, can my right hon. Friend say exactly what is intended to be done for women who present themselves after 20 weeks for a termination of pregnancy? Very often these are women who do not seek advice early in pregnancy, they are unable to take proper contraceptive care and there are also medical conditions that present themselves after 20 weeks of pregnancy. If my right hon. Friend means that they must all be dealt with in National Health Service hospitals, is she prepared to give a guarantee now that facilities for women to have a termination of pregnancy operation will be made available in every region in the country? Is she aware that one of the major abuses is that in many regions women are not able to get the termination of pregnancy to which they are legally entitled? This is an abuse which needs urgent attention.

§ Mrs. Castle
My hon. Friend is right in the first part of her question. There has been a dramatic fall in the number of foreign women coming to this country for an abortion. In 1974, about 51,000 abortions were performed on women resident outside the United Kingdom, which represented a fall of about 10 per cent. on the 1973 figures. In the first eight months of this year there has been a decline of about 30 per cent. on the figures for the corresponding period in 1974. I think that my hon. Friend is right also in saying that this is connected with the more liberal abortion laws obtaining overseas. On a recent official visit to France one found almost open recognition of the changes that were taking place as a result of the alterations in the abortion law in France.
I also agree with my hon. Friend that there are areas of the National Health Service where facilities provided by Parliament under this legislation are not available. This is connected with my earlier reply about doctors and conscientious objections. I should like to see a more uniform and better coverage of provision in the National Health Service, which is one of the Lane Committee recommendations, because this would reduce dependence on the private sector which has been the source of abuse.

§ Mr. McNamara
I congratulate my hon. Friend and the Government on their 252 decision to bring back to the House the question whether a Select Committee should be established. Whatever views individuals may have on this issue, it is right that this matter should be decided by the House on a free vote, and my right hon. Friend is to be congratulated on what she proposes to do.
Is my right hon. Friend aware that, as a member of the Select Committee, I paid particular attention to the question of counselling and the provision of counselling facilities? It is most importand that my right hon. Friend should not only lay down procedures but should ensure that there is adequate training and that all the facilities and alternatives are known not only to patients but also to those who are giving the advice.

§ Mrs. Castle
I am grateful to my hon. Friend for his congratulations to the Government, and I pay tribute to his work on the Select Committee. He is right in saying that counselling is an important part of this procedure, and, as I said in an earlier reply, counselling will include the full presentation of alternatives that are available. With regard to my hon. Friend's suggestion that this should involve careful training, I hope that this is one matter that will be dealt with effectively and helpfully in the consultations that I am having with organisations representing medical, nursing and social workers.

§ Mr. Goodhew
When the right hon. Lady says that the reconvening of the Select Committee should be left to a decision of the House by a free vote, does she mean a genuine free vote on this issue or the sort of so-called free vote that we had on the Murder (Abolition of Death Penalty) Bill when the Labour Party was whipped through the sponsor's Lobby by the then Government Chief Whip, the present Leader of the House?

§ Mrs. Castle
I think that the record of this Government in recognising that a sensitive subject is a matter for individual conscience is unparalleled. I think that once again the hon. Gentleman is unfairly and unnecessarily trying to stir it up, especially when one remembers the free vote that was fully operational on our side of the House for the Second Reading of the Bill.

§ The Lord President of the Council and Leader of the House of Commons (Mr. Edward Short)
On a point of order, Mr. Speaker. What the hon. Member for St. Albans (Mr. Goodhew) has just said is utterly untrue.

§ Mr. Goodhew
I assure you, Mr. Speaker, that I was a Teller in the Lobby on one occasion when the right hon. Gentleman cleared the Lobby and whipped hon. Members through it.

Dr. M. S. Miller
As a member of the Select Committee, may I congratulate my right hon. Friend the Secretary of State on the alacrity with which she has acted on our recommendations? Does not this indicate that the area of abuses of the Abortion Act 1967, which quite rightly agitated the House and the country, has now been cleared for action by her Department? I commend her for repudiating the allegations made by the hon. Member for Birmingham, Edgbaston (Mrs. Knight) about directives to doctors. If I believed that directives of the kind the hon. Lady mentioned applied, I should be extremely concerned. When my right hon. Friend considers abuses of the Abortion Act—and there have undoubtedly been abuses—will she take into account the abuses to which my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) referred, namely, abuses of an Act of Parliament because many women in this country cannot take advantage of this legislation because of the attitude of some members of the medical professions?

§ Mrs. Castle
I am grateful to my hon. Friend for his generous remarks about the speed with which we have acted. We have acted with speed because throughout it has been our policy to deal with these abuses vigorously and comprehensively. We had already proceeded against a number of the abuses, but undoubtedly the work of the Select Committee, on which my hon. Friend played a distinguished 254 part, has helped us to complete the work. I am confident that in the list of measures I have announced there will be a comprehensive and effective attack on those abuses, which will be eliminated.
I am grateful to my hon. Friend for his remarks about doctors with conscientious objections. He is right. It would be intolerable if directives of the kind which the hon. Member for Birmingham, Edgbaston (Mrs. Knight) insinuated were to be issued. My Chief Medical Officer would be the last person to agree with them.
I agree with my hon. Friend the Member for East Kilbride (Dr. Miller) that there are areas in the National Health Service in which women are unable to obtain the facilities provided for by Parliament, and many of them have been driven to the private sector. In difficult circumstances I shall do my best to provided a uniform service.