Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 320-339)


24 OCTOBER 2007

  Q320  Chairman: I think the Committee members, who are of different persuasions, would share the view that if abortion is taking place it should be taken earlier rather than later. But would you consider, for instance, the advice from the Royal College of Obstetricians and Gynaecologists and the BMA about first trimester abortions and of getting rid of the two doctors' signatures which seem to be a barrier to early abortion? That would require legislation.

  Dawn Primarolo: It would require legislation.

  Q321  Chairman: And that would be the Government following its policy.

  Dawn Primarolo: And if the House decides—because it has always been agreed that these matters are decided by the House. But the information under the current arrangements is that 89% are before 13 weeks—and we continue to try to improve the service—and 68% are ten weeks or less. That seems to be the correct way to go. I have confined myself, very clearly, Mr Willis, in making sure that, as the law currently stands, the Health Service is pursuing policy as expressed by this House in debate, and that includes, wherever possible, ensuring that abortions are taken as early as possible.

  Q322  Chairman: On the point that Nadine is making in terms of policy, in terms of getting it from late to early, if you felt that a change in the law would facilitate that, you still would not do that unless it came through the private Member route.

  Dawn Primarolo: No, it would have to be a matter for the House. It would have to be a matter for the House because views are so strongly held. I speculate here, but the Department would be required to come to the House if there was a problem; but, given the percentage, the assessment is that there is not a problem and, therefore, although there are increasing views expressed with regard to two doctors or one doctor, that would still have to be a matter for the House and not for Government. That is the position the Government has held for some time.

  Chairman: One of the key areas we are dealing with at the moment is this question of viability. I want to bring Dr Turner in.

  Q323  Dr Turner: The Infant Life (Preservation) Act 1929 still makes it an offence to intentionally kill a foetus capable of being born alive. The Act stipulates that if the foetus is 28 weeks of gestation or older it is capable of being born alive. What does "capable of being born alive" mean to you and to the Department? Does this Act possibly confuse "vitality" with "viability"?

  Dawn Primarolo: We take the clear consensus—and I will come back to this time and again in terms of the evidence presented here this morning—in the way that the Department proceeds. In particular, we would be looking at the survival rates to discharge as a measure of viability with regard to the 1967 Act. I can say to you that all the research and information we have and the consensus view is that survival to discharge is the point of viability—which helps reinforce that concept—and at 21 weeks it is 0%; at 22 weeks it is 1% and then it increases quite markedly at 23 weeks to 11%. In this very complex area with regards to time and viability, we are following the medical consensus, and that medical consensus still indicates that, whilst improvements have been made in care, at the moment that concept of viability cannot continually be pushed back in weeks: it is a matter of development and therefore survival rates. That is where we draw our views on that matter.

  Q324  Dr Turner: Do you currently see whether there is a legal age of viability? In answering that question, if you could give your view on the latest data concerning the viability of those highly pre-term and pre-term babies it would be helpful, because the two things go together.

  Dawn Primarolo: I will ask Paula to answer in a moment on the question of the legal status. The Act clearly makes requirements with regard to time limits. The results of studies commissioned by the Department which I have just quoted for 1995, and I understand that the latest results will show similar—

  Q325  Dr Turner: We have seen a private view of that data.

  Dawn Primarolo: Certainly the advice from the British Association of Perinatal Medicine—which I think they have also stated in their evidence to you—is that a lowering of the legal definition of viability, as we operate it, to discharge, would imply that the viability of survivals have improved, and they have not on the consensus of evidence we have. Some disagree with that, of course, but, in drawing on all the evidence, we draw to the point where the consensus—

  Q326  Chairman: Whose evidence do you rely on?

  Dawn Primarolo: We are relying on the BMA; the RCOG; the RCN; the EPICure studies. We are relying on the British Association of Perinatal Medicine; the Department's library tracts; research in this area. We make sure that, if relevant, it is drawn absolutely to the attention of the officials who will be concerned with this area. There are regular meetings and discussions between the experts. We also would track right down to newspaper articles and reports. We are looking at international research and consensus. So we are drawing as widely as possible to have a clear position—or as best we can have a clear position—on what are very difficult issues. Hence my point that I can say to the Committee what the Department knows and how it deals with these areas in the operation of the Act.

  Q327  Dr Turner: It would be fair to say, then, that as far as the Department is concerned there has been no significant change in the perceived link between age and viability of 24 weeks and the upper abortion limit under present legislation of 24 weeks. But there is one important point that would also affect the 24-week viability data, and that is what "24 weeks" actually means in practice. It is my understanding that when births are reported, a delivery in the 24th week of gestation could be 24 weeks and no days or up to 24 weeks and six days. That can make quite a considerable difference. Do you feel that there is any need to be more precise about the meaning of the 24th week, especially given the fact that measuring gestational age is not a totally precise science?

  Dawn Primarolo: Anything that is "24 weeks plus" is over.

  Q328  Chairman: By one day?

  Dawn Primarolo: Yes. That is my understanding.

  Q329  Chairman: Could we ask the lawyer if that is her view, please?

  Dawn Primarolo: Yes, we can. But we are also held here with the issues with regard to the medical judgment: the doctor is quite clearly acting within the guidelines that are issued through the medical profession as to the proper interpretation and, therefore, how the doctor is expected to make that judgment with regard to the time it is. I am happy to ask the lawyer whether I have that wrong.

  Ms Cohen: The 24th week is 23 weeks plus six; so 24 weeks plus one is over the legal time limit[1]. As to when to start the calculation, commentators have looked at that and outlined the various different dates, none of which have, as it were, reached a conclusive conclusion on when to interpret the period from.

  Q330 Dr Turner: This is an important point. Could I ask Dr Adshead what medical practice in reporting deliveries is. In other words, when you receive your data, what does 24 weeks mean in practice?

  Dr Adshead: Twenty-four weeks is, as interpreted by the Act—the Minister is correct—that one day and 24 weeks is not 24 weeks. The point the Minister makes around the issue of the doctor's view is absolutely critical, because, as we know on a case-by-case basis, it is absolutely critical that two doctors both advise the woman, look at the context for her and her health and the broader issues for the family as well, and, whilst gestational age in terms of being able to do that from a clinical point of view, in terms of determining data, has improved vastly since the amendment was made in 1990, there can still be some variation. That is why we think it is so important that also the clinical view is taken into account as part of this.

  Q331  Dr Turner: What is your current estimation of gestational age?

  Dr Adshead: We do not collect data on that. We rely on the clinicians recording—

  Q332  Dr Turner: You must have a view.

  Dr Adshead: I do not have a specific view on that. I do not know what that would be.

  Q333  Dr Turner: We have been given estimates of, say, plus or minus a week. Does that sound reasonable to you?

  Dr Adshead: That sounds within the time limits that you might expect but I do not know the precise answer to your question.

  Chairman: Could I bring in Nadine, please.

  Q334  Mrs Dorries: You quote the EPICure study, which as you know, I am sure, averages out the statistics across the UK of all the hospitals. Are you aware of some practices taking place in some of your own hospitals, such as Hope in Salford and University College Hospital London, which report survival rates in neonates at 23 weeks as 42% and at 24 weeks as 66%? You also quoted you took information. Are you aware of the Hux(?) report from Spain: at 23 weeks it is 66% and at 24 weeks it is 82%? If you look at individual units where there are good neonatologists and good neonatal units, the survival rate is much higher. Therefore, do you still feel the rate of viability of 24 weeks is right, given that you are depending on information which simply averages out, across the UK, bad and good practice?

  Dawn Primarolo: Yes. I have tried to make it clear—and I will make it clear again—that I am not saying that all the evidence is brought together here. We are looking at the consensus, quite clearly, on large studies and the figures that I think you said you already had, Mr Willis, were with regard to survival rates at 21 weeks, 22 weeks and 23 weeks, and certainly the evidence with regard to the British Association of Perinatal Medicine is pointing quite clearly to the point that viability, whatever the vast improvements—and there are significant improvements—cannot constantly be pushed back in terms of the date.

  Mrs Dorries: I am sorry, that is not right. That is not correct.

  Chairman: Would you ask a question, please.

  Q335  Mrs Dorries: I am sorry. That is not correct. EPICure has not shown that. EPICure has simply taken the forms which have been returned to it from hospitals across the UK stating viability figures. It has not taken into account the performance of individual hospitals across the UK where the survival rate of infants is much higher than EPICure suggests. Would you not accept that in your own hospitals viability rates are quite high where there are good neonatology units?

  Dawn Primarolo: I am putting two sets of evidence that compliment the conclusion about viability and development which is regardless of significant improvements in particular hospitals. It is to do with the viability, for instance, of whether the lungs are developed or not. I am trying to be very careful with the Committee because I understand that, as in Parliament, there are very different views. To play this with a straight bat to the Committee, the consensus of the scientific information is still clear and the medical advice is still clear with regard to survival rates under 24 weeks. I would absolutely acknowledge that there are improvements in care but the advice is still the same to me in terms of the survival rate below a certain date.

  Q336  Chairman: We could argue this, Minister, and you have made your position clear, but, in policy terms, the question is whether in fact the policy says we look at the average across all units, in all types of settings—which currently is 24 weeks. That is the basis and that also gives the protection in law from the 1929 Act. The point which some members of the Committee are making is that the policy should reflect the very best that is achievable and, therefore, that rate should come down. Would you concede that that is a legitimate point of view and one that the Government should consider?

  Dawn Primarolo: It is not for me to say it is not a legitimate point of view, it is not—

  Q337  Chairman: I am sorry, it is an alternative point of view, and should the Government consider it.

  Dawn Primarolo: It is an alternative point of view, but it is not the view the Government holds. Of course, in considering any of these matters, the Department of Health, in its advice, would need to look very carefully at all of these issues to see whether or not ministers were receiving the best information that was available to reach a consensus. The advice to me, apparently, is that that is what the Department does. I absolutely hear the point that is being made. I am not disputing whether it is an alternative way to consider this, I am explaining how the Department proceeds in gathering all the information in what is a difficult area to come to a conclusion on the consensus of medical opinion. We do not rely on just one source of information, clearly we have to balance a whole range of sources.

  Q338  Dr Turner: Is it fair to say that the Department's view is that in the light of all the evidence you are currently content with the present 24-week limit?

  Dawn Primarolo: The Department's view is yes. At the moment that is what Parliament have decided and that is where we are. You are asking me for information of whether that seems a sensible position to hold. I am saying yes, because that is the information that comes to me. I want to be very careful here, though, Dr Turner: it is for the House to decide on that. I am explaining how the current limits operate and why we think they are the right limits, bearing in mind the information we have.

  Q339  Dr Turner: I am simply seeking the Government's view on that.

  Dawn Primarolo: The Government does not have a view. I am giving you the Department's information. It is a matter of conscience for the House.

1   Note from the Witness: The Department has submitted a memorandum to correct this sentence. Back

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