Examination of Witnesses (Questions 200-219)
DR VINCENT
ARGENT, DR
TONY CALLAND,
LIZ DAVIES
AND KATHY
FRENCH
17 OCTOBER 2007
Q200 Dr Iddon: The question was:
would the BMA object to nurses stepping in to this role?
Dr Calland: The BMA discussed
this at their conference. They did not support nurses stepping
into this role.
Q201 Chairman: Could I follow that
up by asking this? In the United States and South Africa where
in fact nurses do fulfil this role in more significant numbers,
and legally do so, is there any evidence that the outcomes in
terms of patient care are any worse than if doctors are involved?
Dr Calland: Personally, I cannot
quote you any evidence but the view at the conference, the debate
at the conference on this issue, was about patient safety. It
was felt, maybe not surprisingly since we were all doctors there,
that it would be safer if doctors did it rather than nurses.
Q202 Chairman: But you have no evidence
to that effect?
Dr Calland: I personally have
no evidence.
Q203 Chairman: Dr Argent, you were
nodding your head then.
Dr Argent: It is just to clarify
that the article published in The Lancet does actually
discuss that. It shows that the outcome data on nurse practitioners
is equivalent to physicians and in fact in some cases better.
Q204 Chairman: What would your view
be then? Would it be that nurse practitioners are perfectly capable
of carrying out procedures?
Dr Argent: I would agree with
my colleagues. Nurse practitioners now do many invasive surgical
procedures, such as colposcopies and hysteroscopies. Some of these
procedures do require more technical expertise than carrying out
early medical and many surgical procedures. I think it is quite
possible that nurses could do early surgical procedures. Indeed
the Faculty of Family Planning now produces a syllabus for training
in abortion care which consists of eight certificates. Currently
nurses are permitted to do one, two and three which concern counselling
and early medical abortion. Their certificates four and upwards
are only available to doctors. The certificate follows a proper
syllabus actually designed to teach practitioners how to carry
out early surgical procedures. That should be open to nurses.
Q205 Dr Iddon: Could we be quite
clear from the panel that those that support nurses being involved
would support nurses being involved right through to the upper
time limitboth trimesters, in other words?
Kathy French: I would not because
I know that the very late terminations do carry risk and it is
a very skilled procedure. Certainly in my previous role it was
very much our more senior doctors who undertook the later terminations
up to 20 weeks. I do not think nurses would want to go to that
level.
Q206 Dr Iddon: We are talking about
early terminations?
Kathy French: I think there would
be a cut-off point for nurses. That is my personal view.
Q207 Dr Iddon: Is that generally
agreed?
Liz Davies: Yes, in the Marie
Stopes' programmes in both Vietnam and in South Africa we have
nurses routinely performing early and first trimester abortions.
We use a fairly unique procedure for this which is not in the
norm, and they are done very safely and there are no adverse outcomes
at all.
Q208 Chairman: What about the second
trimester?
Liz Davies: No, this is limited
to the first trimester. I would support Kathy that we need more
skilled doctors to provide later termination.
Dr Argent: In the United Kingdom
there is a very small number of gynaecologists who carry out dilatation
and evacuation surgical procedures after 16 weeks. It is a fairly
specialised technique because the procedure at that stage becomes
more difficult. The Royal College has said that these colleagues
must be appropriately trained and maintain a sufficient caseload.
Practising gynaecologists will tell you that there is a world
of a difference between doing a surgical dilatation and evacuation
at 20 weeks and an MVA or a suction termination at, say, six to
ten weeks.
Q209 Mrs Dorries: I have a number
of questions for Kathy and one for Liz. Kathy, perhaps I should
declare that I was a member of the Royal College of Nursing until
I started my present job. Kathy, could you inform me why in your
evidence you quoted non-peer-reviewed studies, those which were
carried out for example by the Pro-Choice Forum on late abortion
and why you only quoted EPICURE when you were talking about survival
rate and did not refer to some of the units in the UK which have
excellent survival rates and are manned by excellent nurses? You
may want to listen to my questions and the grouping. I also want
to ask you if you consulted all RCN membersand I ask this
as a previous member of the RCNwhen you were taking your
position? Was it just a small committee in the RCN that took its
position and if so, why and why did you not feel it appropriate
to discuss this with all nurses, given that this is such an important
issue?
Kathy French: I will take the
second question first, if I may. Any evidence we give to any committee,
even if it is the National Institute for Health and Clinical Excellence,
we only consult with the members which are affected. If it is
mental health, it is the mental health forums. In this situation,
it was nurses who work within sexual health and gynae who are
members and some of our members who work in private organisations
as well who are members of the termination of pregnancy network.
It is those sorts of groups with which we consulted.
Q210 Mrs Dorries: Kathy, this issue
has huge consequences for many people and a lot of your nurses
are happy about the fact that you have not consulted with them
because this has moral and ethical implications.
Kathy French: I think if it was
a moral and ethical issue, we would have consulted with all our
members. This was really about the scientific bit around the care
of the women. It resulted in our looking to our members.
Q211 Mrs Dorries: Why did you quote
in your evidence non-peer-reviewed studies, such as those by the
Pro-Choice Forum and why did you only refer to the EPICURE study
when many of your nurses are working in units with fantastic survival
rates?
Kathy French: I did not write
that bit. I am here on behalf of the Royal College of Nursing,
so I cannot take that up but I can certainly find out why, if
that helps.
Q212 Mrs Dorries: This is a question
to Liz. It is fortuitous that you are here this morning, given
that your organisation has just published a report this morning.
That reports says that two-thirds of GPs want the time limit for
abortion reduced from 24 weeks. Could you perhaps elaborate on
that study and tell us how many doctors were surveyed and what
questions were asked of doctors?
Liz Davies: I do not have the
study with me. Of the 45,000 GPs in the UK, 1,000 were surveyed
and two-thirds of those were in favour of the legal limit being
reduced. We do not necessarily of course agree with their opinion.
Q213 Dr Harris: Was there a 100%
response rate? There was a 100% return on the survey, was there?
Liz Davies: I confess that I am
not sure of those figures.
Q214 Dr Harris: You are saying two-thirds
of those who returned the form?
Liz Davies: I do not have that
with me.
Q215 Chairman: Liz has said she does
not have those details. It is not fair to press her.
Liz Davies: It is two-thirds who
did respond.
Mrs Dorries: Two-thirds of GPs who responded
to your survey want the upper limit reduced from 24 weeks.
Q216 Dr Turner: Current legislation
restricts the carrying out of abortions to specifically approved
premises. Do you think we need to do more research to determine
the appropriateness, practicality and acceptability of widening
the range of physical circumstances in which abortions could be
carried outfor instance, the home?
Dr Calland: The BMA debated this
in the motion at conference in the summer and the view was that
there should be no change in the registration of premises. That
is where we sit.
Q217 Dr Turner: Does anyone else
have a view on that? Can you expand further on the thinking behind
the BMA's position?
Dr Calland: It was about patient
safety and considering, as I have indicated, it is a conference
of doctors, they felt that there were appropriate safeguards in
place with the current situation and they could not see the need
at the moment to alter it.
Q218 Dr Turner: There could not be
an element of: well, they would say that, would they not?
Dr Calland: You might say that.
Q219 Chairman: Could you tell Dr
Turner the evidence base for that?
Dr Calland: It was opinion.
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