Abortion today is an extremely safe, straightforward procedure, provided in a highly regulated environment. One in three women in the UK will have an abortion in her lifetime, funded by the NHS (except if she lives in Northern Ireland). This will usually take place within an NHS hospital or in a centre run by one of the independent charitable providers – the British Pregnancy Advisory Service (BPAS) or Marie Stopes International (MSI). But just because it is safe doesn’t mean corners can be cut, or providers can pick and mix from rules and regulations, as was unearthed in the course of the care quality commission’s investigation of MSI.
Some of the failings found at MSI have no implications for safety. The batch signing of abortion forms, for example, has no clinical significance – it is simply a legal requirement that all women have their abortion request legally authorised by two doctors. But the other problems uncovered – from clear deficits in clinical governance at the top level through to problems with safeguarding and consent, to the report of the appalling handling of a vulnerable patient – can leave us in no doubt that the CQC was not over-reacting when it requested MSI suspend its services over safety concerns earlier this year.
Clinical supervision and governance structures, training and upskilling staff and recruiting the right people to leadership positions takes time – and money. Adhering to legal requirements that have no clinical benefit may be irksome and expensive, but that’s life. If you operate in a highly regulated environment and believe women deserve high-quality care, these measures are not optional.
Abortion is an easy procedure when everything goes right – but you can’t run a clinical service on the assumption that everything runs to plan. The best doctors experience patients who develop complications, unexpected problems arise in the healthiest patients, clients need access to good counselling services and support. Research and innovation is essential to determine best practice. This costs – but it’s not just a matter of cost but of commitment, and focus on values.
The BPAS has been delivering not-for-profit services since the 1967 Abortion Act came into force, providing high-quality, compassionate care that the NHS either could not, or would not provide from its own facilities. It was founded by a former abortion law reformer who saw that the inability of the NHS to meet women’s needs would push them into paying extortionate sums for poor-quality care by private doctors.
In the 1970s, MSI joined BPAS as a charitable provider. Today some 200,000 women a year in the UK have an abortion. MSI provides about a third of all abortion care , BPAS a further third, and the remainder are performed in NHS premises.
In a parody of market economics, the two charities now compete with each other and with local NHS hospitals for regional contracts to provide NHS abortion services. With NHS funds shaved, the price commissioners will pay is driven down. In the current commissioning environment a cheaper service will trump a quality service almost every time.
We all deserve an honest and open discussion about how this essential women’s healthcare service is commissioned and provided in an environment of cost-cutting. On the brink of the 50th anniversary of the Abortion Act, BPAS is absolutely clear, abortion must be fully decriminalised and women finally trusted to make their own reproductive choices for themselves – and they must be able to exercise those choices in clinics providing safe, high-quality abortion care.
