Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 200-219)


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 limit—both 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 members—and I ask this as a previous member of the RCN—when 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 out—for 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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