Below is the text of the speech made by Roland Moyle, the then Minister of State at the Department for Health and Social Security, in the House of Commons on 19 April 1978.
I shall try to deal with the questions affecting my responsibilities as one of the Ministers responsible for the administration of the Abortion Act. First, however, I must remind the House that the Government take no collective view on the moral questions of abortion in the belief that individual Members should make their own judgments on these matters.
My hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) invited me to remind the House of the measures taken by my Department to control the private sector of abortion and to comment on whether I agreed that these measures are effective. It might help if I indicate to the House the range of undertakings which private nursing home proprietors must give my right hon. Friend as a condition of his approval under the Abortion Act.
Briefly, they provide for the maintenance of detailed records, the inspection of premises and records by the Department’s officers at any time without notice, the giving of receipts to patients and the retention of copies for inspection, the acceptance of fees only after two doctors have certified that the Act’s criteria are met in each case, the number of patients per 24 hours not to exceed the number of beds approved, and for the examination of patients by a doctor before discharge.
The nursing home must also undertake not to advertise abroad, either directly or indirectly, employ touts, or to accept patients who have been diverted from their intended destinations or touted for. The proprietors must have no connection with agencies or persons known to advertise abroad, or to tout for or divert patients.
Proprietors must also, in applying for approval, provide the Department with detailed information about the business arrangements of the companies and individuals involved in the application, all of which is carefully inquired into by the Department’s investigators. Medical and nursing arrangements, including staffing, equipment, procedures and accommodation, are checked by the Department’s medical and nursing teams.
Nursing homes which concentrate on abortions have had to satisfy my right hon. Friend that the total costs charged to abortion patients treated on their premises are not unreasonable, and must not increase these costs without prior approval. All financial arrangements between nursing homes and doctors, other than payment of fees, and pregnancy advice bureaux must be reported to the Department.
I think that it will also be worth while on this occasion, having dealt with nursing homes, to focus on the arrangements for registration of approved advice bureaux, as this register was established only early last year.
The background to the register is that, under the Abortion Act 1967, only places which carry out termination of pregnancy are required to be approved for that purpose by the Secretary of State. This means that nursing homes that carry out abortions, in addition to being registered with the local health authority, also have to satisfy the Secretary of State that they should be approved for carrying out abortion, whereas the bureaux which advise and refer women for abortion neither require approval under the 1967 Act nor need to be registered with the local health authority.
In the early years, following the implementation of the Act, and in the absence of control of any kind, a large number of small referral agencies mushroomed, mainly in London. It was these agencies that saw some of the most blatant abuses of the Abortion Act and caused public concern—such practices as touting for patients, employing persons to divert patients from their intended destinations, and canvassing abroad for patients. This led the Lane Committee to recommend that, whilst the existing control over nursing homes appeared to work very satisfactorily, there ought to be a system of licensing pregnancy advice bureaux.
Even while the Committee was sitting, my Department had adopted a system of blacklisting undesirable agencies. Approved nursing homes were warned that if they accepted referrals from such agencies they would risk losing the Secretary of State’s approval. As a result of the blacklisting of 23 agencies, these abuses were eliminated and most of the people concerned put out of business. In 1975 the then Secretary of State accepted a recommendation by the Select Committee on the Abortion (Amendment) Bill, based on the conclusions of the Lane Committee, that this form of control should be extended by requiring approved nursing homes to give an assurance that they would accept only patients referred from pregnancy advice bureaux who were on a register approved by the Secretary of State. The first register was published on 10th February 1977 and there are now 35 registered bureaux; nine applications have been refused. Registration will be reviewed and, as appropriate, renewed on 1st October this year.
Before registration, each bureau is inspected to ensure that the accommodation and facilities for counselling and medical assessment on the premises are of reasonable standard; counsellors are interviewed and counselling notes inspected to assess, as far as it is possible to do so, the standard of counselling to be provided to clients and the business arrangements inquired into to ensure that undesirable persons are not involved and that all is above board.
In addition, registered bureaux must subscribe to various requirements governing their conduct. Amongst other things, these prohibit advertising abroad and association with touts and require the maintenance of proper records, the giving of receipts, and consultation with my Department about the methods of advertising in this country. All registered bureaux have received a copy of my Department’s counselling circular, and they are expected to provide counselling in accordance with its central requirement that women should make up their minds in the light of all the relevant facts about their situation and about the alternatives to abortion which are open to them. The register appears to be working well.
As with approved nursing homes, all registered bureaux are subject to unannounced visits by my Department’s inspecting officers. One of these officers is always a doctor, authorised to inspect counselling notes and medical records and to discuss counselling and medical procedures at the bureaux with the counsellors and doctors concerned. The other member of the team, an administrative officer, checks facilities, staffing and accommodation and general records and receipts. A full report is made on every unannounced visit.
Bureaux may also be visited by the Department’s special investigators, who are ex-police officers, either at random or as part of wider inquiries, and the opportunity is taken to check records—other than patient records—staffing and procedures at the premises. So far it has not been necessary to remove any bureau from the register for failing to comply with the requirements of registration. My right hon. Friend, however, will not hesitate to do this, if necessary; nor will he hesitate to take firm measures against any approved nursing home which he finds has acted contrary to assurances given to him. I am of the opinion that the present system of administrative control, including as it does now the registration of pregnancy advice bureaux, is effective in preventing abuse and flexible enough to react quickly to any change in circumstances.
The second main issue which has been raised with me concerns the effects of the 1967 Act over the first 10 years of its operation and, in particular, the extent to which the NHS has provided facilities for abortion. The statistics published regularly by the Office of Population Censuses and Surveys show that the number of abortions performed under the Act increased steadily up to 1973 when there were 167,149 abortions performed in England and Wales of which 110,563 were performed on women resident in England and Wales. The number of abortions notified in 1977 was 132,999 of which 102,237 were notified as being performed on resident women. The rate of abortions per 1,000 women aged Is to 45 years also increased up to 1974, but decreased after that, and appears to be significantly lower than the rate in countries with similar legislation.
It is difficult to establish what the long term pattern will be, but, for those of us who lay emphasis on prevention, there are encouraging signs that the free family planning services are helping to reduce the number of unplanned pregnancies. A survey of family planning use between 1970 and 1975 published yesterday demonstrates the growing use of more effective birth control methods particularly amongst those groups which previously seemed least inclined to use the family planning services. The most recent figures on births and abortions show that the rate of extramarital conception, measured approximately by adding figures of illegitimacy, pre-nuptial conception and legal abortion amongst the young, is decreasing. For example, the rate of extramarital conceptions per 1,000 women in the age group 16 to 19 fell from 60·4 per 1,000 women in 1972 to 45·8 per 1,000 women in 1976—a fall of 24 per cent. A similar decline occurred in the 20 to 24 year age group. Even in the under-16 age group, where the numbers are small but of considerable concern to us, the figures, which showed a rise up to two per 1,000 in 1973, remained steady thereafter.
On the question of NHS abortion facilities, I fully accept that provision varies considerably among different parts of England, and overall the NHS performs only just over half of all abortions on women resident in England and Wales.
But we are determined to improve NHS facilities. The letter of guidance which went out with the £50 million announced by my right hon. Friend the Chancellor in the Budget Statement last week in fact states that some of the money could be spent on day-care termination facilities.
As a result of recent activities, I am happy to say that my Department has had discussions with two regions about improving abortion facilities—namely, Wessex and the West Midlands. I have noted that the West Midlands Regional Health Authority has accepted its working party’s report on abortion facilities in that region, which proposed the provision of day-care facilities for abortion supported by arrangements for counselling. I am sure that my hon. Friend will regard that as a considerable advance.
On the question of the Barking case, I understand that papers relating to the incident at Barking Hospital were referred to the Director of Public Prosecutions, who considered them and con- cluded that there was no evidence of a criminal offence.
My hon. Friend also raised the question of the Droylesden case. Mrs. Chester, the lady who made the accusation, refused to be interviewed or to give any further information about the allegation, other than what she had been told about the notice by a staff nurse. The editor—
[Time ran out and the house was adjourned]