Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 180-199)


17 OCTOBER 2007

  Q180  Chairman: Could you please answer the question? The question has been put in the inquiry.

  Dr Calland: The reason that that particular motion was chosen by the Agenda Committee—this is the motion on first trimester abortion—was because we did not have policy in that area. We knew that the Abortion Act was going to be reviewed because of the 40th anniversary and the opportunity was there.

  Q181  Mrs Dorries: Dr Calland, that is not the answer to the question that I am asking. The question I asked you was: on the day that the motion was voted on, were only pro-choice motions put to the floor of the BMA?

  Dr Calland: No. There was a series of motions. I can read them all out to you if you wish.

  Q182  Mrs Dorries: There were three.

  Dr Calland: There was more than that. There was a series of motions. The first of those motions was the motion on first trimester abortion and that was debated. As I am sure you are aware, time is allowed for certain sections and after that motion, because there were a lot of speakers and it was a well-attended debate, time on that section ran out. Therefore, we did not get to meet the other abortion—

  Q183  Chairman: Are you Chair of the Agenda Committee, Dr Calland?

  Dr Calland: I have nothing to do with the Agenda Committee whatsoever.

  Q184  Chairman: For the record, who is the Chair of the Agenda Committee?

  Dr Calland: I am not sure if it is not the Chairman of the whole conference.

  Q185  Chairman: Could we have that for the purpose of our records?

  Dr Calland: Michael Wills.

  Q186  Dr Harris: May I suggestion that if you write to us with the correspondence that addressed the question in the first place, then we can circulate it. It is a procedural matter. I would also like to ask if you could write clarifying, because I cannot find it in your evidence at all, any reference to two signatures in the second trimester. I would be grateful if you would take the opportunity to write to say whether you have a policy on the second trimester and, if so, on what that is based.

  Dr Calland: The policy on the second trimester is to maintain the status quo. It was that we changed it for the first trimester.

  Dr Spink: Kathy, in reference to two doctors, talked about the need to get two signatures being a huge burden—your words—on women and about it being very inconvenient. There was no mention at all of the health impact or the ending of a life and the moral impact of that. Dr Calland has pointed out that the BMA is focused on the health risk to the woman, not on the consequences of this unique procedure, which is one to end life rather than to save and improve the quality of life. Does the panel think that there might be other dimensions to this decision on two doctors, other than just health, that there might be moral and ethical questions as well and protection for the doctor and protection for the parent who is looking to abort, who may come across somebody with a particular view, and if they have two signatures, that will make the probability of them coming across a doctor with a particular view—

  Chairman: I am not allowing any questions which ask our witnesses for moral or ethical views. I am keeping purely to the facts. I am sorry, Bob. I know you are trying to get in there, but I will not allow it.

  Dr Spink: I regret that, Chairman, because for the record could I just state that I believe that science must also look at the moral and ethical consequences and you can do that.

  Chairman: You can do but you are not going to do it in my committee at the moment.

  Q187  Chris Mole: Kathy French, what evidence is there to back up the RCN's argument that nurses should be given more responsibility in medical abortions?

  Kathy French: We do not do it. We have to work within the legal framework at the moment and we know that our colleagues in other countries have a greater role around abortion. In terms of early medical abortion, currently nurses provide all of the care for the women, apart from prescribing the medication needed. Many of our colleagues tell us that this is a great disadvantage to them, that they could actually speed up the process once that woman has decided that is her option. This is not all our members within the College; these are nurses who are specifically working in the field of abortion. It is not asking for every nurse out there to take it up and we know that every nurse will not want to, any more than they will want to prescribe for other conditions.

  Q188  Chris Mole: Can you be clear: does the RCN actually have a view on what additional roles those nurses working in abortion services could be taking on if there was a change in the law?

  Kathy French: Yes. Can I explain to you? If you are looking after a woman who has decided to have an early medical abortion, nurses currently provide all the care. The one thing they cannot do is prescribe the medication. It is that extra step that some nurses would like to take.

  Q189  Chris Mole: But they can prescribe most of the medication for other procedures?

  Kathy French: If you are a nurse prescirber, you can prescribe anything in the National Formulary but not mifepristone.

  Q190  Chris Mole: But they can prescribe mifepristone for other procedures?

  Kathy French: For other conditions, yes, but not for abortion.

  Chairman: Can we ascertain whether you are you talking purely about medical abortions that you want nurses involved in?

  Q191  Chris Mole: That was the question. The counter argument that is raised is that you require doctors for reasons of safety and not nurses. Does the RCN have a view on whether nurses could carry out surgical abortions safely?

  Kathy French: Yes. Our view is that nurses' roles have evolved over the years. I do not think anyone in 1967 would ever have imagined what nurses are currently doing now, or some nurses, not all nurses, in terms of prescribing, hysteroscopies, colposcopies, fitting of intrauterine contraception and subdermal implants. These are gynaecological procedures. There is a small group of nurses within abortion services who would like, with appropriate training, and it would have to be with training, as part of the medical team to be able to do the very early medical abortions. This is what they tell us.

  Q192  Chris Mole: You said the one thing they cannot do is prescribe. Another thing they cannot do is take consent and sign the HSA1 form. Do you think a properly trained nurse should be able to do that?

  Kathy French: They can take consent. That is very different. They can take consent for abortion but they cannot sign the form.

  Q193  Chris Mole: Do you think they should be able to?

  Kathy French: Yes, I think for nurses who are appropriately trained and who want to and also respecting those nurses who have a conscientious objection, that must be respected. We are not talking about volumes of nurses working in isolation in a portakabin. It is nurses as part of a team who are trained and very experienced and it is not going to be large numbers.

  Q194  Dr Iddon: Could you spell out in a little more detail what in practice nurses are actually doing now? You have explained that with medical abortions but could you go into a little more detail for surgical abortions?

  Kathy French: In terms of nurses, nurses do all of the counselling for women around abortion. They will do ultrasound scans in many of the units, certainly in the one that I worked in, take the bloods, discuss ongoing contraception, get consent from the women, discuss the procedure. In day surgery units, they care for the women in pre- and post-op procedures in terms of pain relief if that is necessary, the complete package of care. Clearly within the law nurses cannot perform abortion. I know this needs clarity because some people still believe that nurses can but we at the College believe under existing law that we cannot.

  Q195  Dr Iddon: Is it your view that if nurses were allowed to carry out particularly surgical abortions but also medical abortions, a doctor should be available in case complications occur?

  Kathy French: Absolutely. This cannot be done in isolation. You would need a doctor there, in the same way that we do now. If a registrar or a house officer is helping out with abortions, there is always the lead consultant or a very senior person within the premises. Yes, you would have to have that.

  Q196  Dr Iddon: Could I ask the panel to comment on the phrase "registered medical practitioner" which is in the current legislation? Some people believe there is a lack of clarity in that. Do we regard nurses as registered medical practitioners or should it be written in more strong language in any further legislation that Parliament may bring in? Any member of the panel could answer that.

  Liz Davies: We took advice from counsel. We sought legal advice on the term "medical practitioner" as contained in the 1967 Abortion Act. The advice came back that the term "medical practitioner" related a doctor registered with the GMC, which effectively bars nurses from carrying out these procedures.

  Q197  Dr Iddon: So in your view we would have to write in a phrase that clearly mentioned nurses in some way?

  Liz Davies: Yes, I think we need to clarify the term "medical practitioner" or just call it "practitioner" to enable nurses to be able to do this.

  Q198  Dr Iddon: Is that generally agreed by all members of the panel? Do any members want to clarify that further?

  Dr Calland: I think the history is that a "registered medical practitioner" has always been taken to mean a doctor registered with the General Medical Council. That was the implication I would think in the 1967 Act.

  Q199  Dr Iddon: Dr Calland, can we be quite clear on the view of the BMA with respect to nurses becoming involved?

  Dr Calland: The BMA does not have a conference policy on this particular issue but generally speaking I think if people in the BMA saw the term "registered medical practitioner" they would assume that meant a doctor.

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