Hi-ho, Hi-ho, its back to the subject of abortion we go courtesy of the Daily Telegraph, whose fact-checking department is evidently still on an extended holiday:

Abortion costs £30m higher than previously thought

No, not really…

Taxpayers spend £30million a year more on abortion than previously thought, the Government has admitted.

No, that’s not quite right either…

Updated figures from the Department of Health also show that, contrary to earlier claims, much more public money goes to private clinics rather than NHS hospitals.

Nope, the Telegraph still isn’t getting it…

Campaigners say the new calculations provide more reason to stop the organisations that offer counselling to pregnant women also performing terminations, which are now estimated to cost £680 each, on the grounds that it represents a conflict of interest.

More bullshit…

They are calling for spending watchdogs to investigate why Parliament was “misled” over the scale of the “abortion industry”.

And no, Parliament wasn’t misled either…

Lord Alton, the crossbench peer who obtained the new figures, said: “I have written to Lord Howe setting out a number of concerns about how Parliament came to be so very badly misled about the costs to the NHS associated with abortion.

Mmm… I think that most pressing concern that Lord Howe needs to address here is Lord Alton’s apparent inability to understand his own fucking correspondence.

Okay, so lets explain exactly what has happened here, which means winding the clock right the way back to 22 July 2008 and a written answer given by the then Health Minister, Lord Darzi, in response to a question tabled by Alton:

Lord Alton of Liverpool asked Her Majesty’s Government:

Further to the Written Answer by Lord Darzi of Denham on 3 July (WA 49), what was the total cost to taxpayers for provision of in vitro fertilisation by primary care trusts following publication of the February 2004 National Institute for Health and Clinical Excellence guidelines; and what was the total monetary cost of abortions funded by the National Health Service over each successive year from 2004 to 2007, together with the proportion of the latter annual sum that was required to cover the cost of abortions taking place in the independent sector under NHS contract in each year. [HL4925]

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): Information on the total cost of the provision of in vitro fertilisation treatment by primary care trusts (PCTs) following the publication of the guideline by the National Institute for Health and Clinical Excellence in 2004 is not collected centrally.

Costs to the National Health Service for abortions performed in NHS hospitals are set out in the following table. The department does not hold complete data on the cost to the NHS for abortions performed in the independent sector under NHS contract.

Year National total cost of medical and surgical terminations undertaken by NHS organisations (Schedule 4 of national reference costs)

2006-07 – £62,886,000

2005-06 – £78,588,000

2004-05 –  £67,637,000

Source: Schedule 4 (NHS trusts and PCTs combined) of the national schedule of reference costs notes:

1. The figures in the table above represent the number of finished consultant episodes multiplied by the national average unit cost.

2. National average unit costs are calculated on a weighted basis.

3. Schedule 4 2006-07 data are not directly comparable to 2005-06 and 2004-05 due to a change in the data collection.

4. Figures have not been adjusted for the market forces factor.

 5. The data collection for 2007-08 is due to start in September 2008.

Keen eyed observers will have noticed the important caveat in that answer –

“The department does not hold complete data on the cost to the NHS for abortions performed in the independent sector under NHS contract.”

Wind forward to March 2009 and we find that Baroness Masham of Ilton asking much the same question, in addition to having one of the best comedy RPG names in the House of Lords:

To ask Her Majesty’s Government for each of the last three years for which figures are available, how many abortions were performed in (a) England and Wales, and (b) Scotland; how many were performed in National Health Service hospitals; how many in private hospitals; what was the cost of performing abortions in National Health Service hospitals and in private hospitals; what was the total number of abortions performed under the Abortion Act 1967; and, of those, how many were performed to save the life of the mother. [HL2275]

Again, Lord Darzi’s answer prominently features the following statement –

“The department does not hold complete data on the cost to the NHS for abortions performed in the independent sector under NHS contract”

In April 2009, John Randall MP, asked:

To ask the Secretary of State for Health what the estimated cost to the NHS was of providing abortions up to nine weeks of pregnancy in the latest period for which figures are available. [268588]

Dawn Primarolo’s response was short and sweet:

This information is not collected centrally.

And in July 2009, Adam Ingram also took a shot at asking the same question:

To ask the Secretary of State for Health how much medical services assigned to the termination of pregnancies under the Abortion Act 1967 cost the NHS in each of the last five years; and what estimate has been made of the cost of such services in 2009-10. [282732]

And got more or less the same figures as before with, yet again, the same caveat:

2. Figures do not include abortions performed by private sector organisations under contract to the NHS.

However, on this occasion, we do get an important additional caveat added to the figures:

3. Figures include day cases, electives (including excess bed days), non-electives (including excess bed days), out-patient procedures and regular day and night admissions.

So, the figures that have beeen given to Parliament since Alton’s first question in July 2008 include the costs of non-elective terminations, i.e. miscarriages

This bring us on to October 2009 and a correction to the information given to Alton (July 2008) and Masham (March 2009):

Baroness Thornton: I regret that the Written Answers given to Lord Alton of Liverpool on 22 July 2008 (Official Report, col. WA227) and to Baroness Masham of Ilton on 25 March 2009 (Official Report, col. WA131, were incorrect with respect to the costs to the National Health Service (NHS) of abortions performed in NHS hospitals in England between 2004-05 and 2006-07. The correct information is set out in the table below:

Total cost of medical and surgical terminations undertaken by NHS organisations £m

2004-05 – 76.4

2005-06 – 81.1

2006-07 – 83.5

Again, these figures include non-elective terminations and, yet again, Alton and Masham are clearly advised that the figure do not include data for abortions carried out by the independent sector under NHS contracts.

In June 2010, we have a stream of questions posed by David Amess about Marie Stopes International, including:

To ask the Secretary of State for Health what estimate he has made of the number of NHS patients who had (a) pregnancy counselling followed by an abortion provided by Marie Stopes International (MSI), (b) pregnancy counselling by MSI and chose an alternative to abortion and (c) had an abortion provided by MSI without having received counselling from that organisation; and what the cost was to the NHS of such services for those patients. [197]

And the short answer…

Anne Milton: This information is not collected centrally.

Not to be deterred, Amess is back only four days later with:

To ask the Secretary of State for Health how much the NHS spent on (a) pregnancy counselling, (b) abortions and (c) other counselling, including post-abortion counselling provided by Marie Stopes International in each of the last five years; and how many people received each such service in each such year. [196]

And, no, that one doesn’t get us much further forward either…

Anne Milton: This information is not collected centrally.

The cost to the national health service of abortions performed in NHS hospitals in 2008-09 was £82.1 million. This figure does not include abortions performed by independent sector organisations, such as Marie Stopes International, under contract to the NHS. In 2009, 60% of NHS funded abortions were performed under contract by the independent sector.

Close enough – the exact figure for 2009 was 59.76% and this is now the fifth occasion on which Parliament has been told that the figure don’t include data on abortions carried out by independent service providers, so you’d think that some might just have got the message by now, but no…

Mr Amess: To ask the Secretary of State for Health what the cost to the NHS was of provision of abortions in (a) NHS hospitals and (b) approved independent sector places in 2009. [2135]

Anne Milton: The cost to the national health service of abortions performed in NHS hospitals in 2008-09 was £82.1 million. The NHS funds abortions undertaken by approved independent sector places under contract to individual primary care trusts. Information on these contracts is commercially sensitive and is not collected centrally.

So exactly which part of ‘we haven’t got a fucking Scooby’ are we struggling with here?

Still, only a month later and fuck me if Alton is back again with the same fucking question…

To ask Her Majesty’s Government what was the cost to the National Health Service of the provision of abortions in (a) NHS hospitals, and (b) approved independent sector places, in (1) 2009, and (2) 2010 to date; and what are the names of those approved independent sector places.[HL736]

See if you can guess what the reply was…

Earl Howe: The cost to the National Health Service of abortions performed in NHS hospitals in 2008-09 was £82.1 million. The NHS funds abortions undertaken by approved independent sector places under contract to individual primary care trusts. Information on these contracts is commercially sensitive and is not collected centrally.

Remember, written questions cost the taxpayer an average of £150 a throw with a disproportionate cost threshold of £750, beyond which a department can decline to give an answer on cost grounds, so our doughty Parliamentarians have already blown more than a £1,000 on questions to which the answer is ‘we don’t fucking know’.

Moving swiftly on to 20 October 2010, we have corrections issued in both Houses which give the following update to ‘we don’t fucking know’:

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): I regret that the Written Answer given to Lord Alton of Liverpool on 6 July 2010 (Official Report, col. WA 31) was incorrect. It should not have included the line that information on these contracts is not collected centrally. I have been advised that the department does collect limited information covering independent sector costs.

The correct reply to Lord Alton is that the department does collect limited information on the cost to NHS providers (NHS trusts and primary care trust provider arms) of contracting services from independent sector providers. A revised response to the question is set out below.

Table 1: Costs to NHS providers of Abortions-2008-09 £m

Cost to NHS organisations of providing abortion – 82.1

Cost to NHS providers of contracting abortions from independent sector providers – 10.4

Source 2008-09 reference costs

Note:

The above excludes the cost of abortions commissioned directly by PCTs from the independent sector, which is not collected centrally. This means that the figure of £10.4 million quoted above is not representative of the total cost to the NHS of abortions carried out by independent sector providers, which in 2009 accounted for approximately 60 per cent of all abortions carried out. Total NHS costs covering 2010 are not currently available.

So now we’ve gone from ‘we don’t fucking know’ to ‘well we do know what all the bureaucracy involved in tendering these contracts costs but we still haven’t got a Scooby when it comes to how much we’re actually paying the independent sector to provide these services.

24 January 2011 and Alton’s back yet again…

To ask Her Majesty’s Government how much they spent on all aspects of abortion funding in England and Wales in each of the last five years; and what restrictions they placed upon such funding. [HL5705]

To which we get this reply:

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): The department does not hold data on the devolved Administrations. For England, the information that is available is set out in the following table.

The department does not collect information on spending by primary care trusts (PCTs) on abortions undertaken by National Health Service providers in England. The department does however collect information on the cost to NHS providers (NHS trusts, NHS foundation trusts and PCT provider arms) of abortions. The following table sets out the cost to NHS providers of abortions between 2005-06 and 2009-10. The figures in the table do not include the cost of abortions performed by the independent sector, which were commissioned directly by PCT commissioner arms, as this information is not collected as part of the reference costs collection.

And there’s another table of figure which shows that direct NHS spending on abortions (including miscarriages) has been pretty much stable during the five years from 2005-6 to 2009-10 at around £82-84 million a year but the costs of commissioning services in the independent sector have fallen from a peak of £17.7 million in 2006/7 to only £7.5 million in 2009/10.

And just to reiterate the point – yet again –

“The figures in the table do not include the cost of abortions performed by the independent sector, which were commissioned directly by PCT commissioner arms, as this information is not collected as part of the reference costs collection.”

On to the 22 March 2011 and Alton’s still obsessing over Marie Stopes International.

To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 10 March (WA 425), how Marie Stopes International (MSI) uses funding provided by them; what recent discussions they have had with MSI about the use of British Government funds; and what response they received from MSI during those discussions.[HL7693]

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): Marie Stopes International (MSI) is a registered charity and provides sexual and reproductive healthcare services including family planning, abortion, sexually transmitted infection treatment and HIV testing both in Great Britain and worldwide

MSI does not receive funding directly from the Government for abortion provision in GB. It is required to compete for National Health Service contracts and is subject to local NHS tendering processes. As part of this process, it is required to demonstrate that it is able to provide a quality, cost-effective service, which meets local needs and which has a focus on wider sexual health provision. The Parliamentary Under-Secretary of State for Public Health, Anne Milton, met representatives from MSI on 29 November 2010 and discussed:

future commissioning arrangements;use of long-acting reversible contraception (LARCs) and the need to reduce repeat abortions; andthe quality of abortion provision and wider sexual health provision more generally.

A note of this meeting has already been placed in the Library.

From 2010 to 2014, the Government are committed to providing £783,106.00 to MSI for its work in Ethiopia, Zimbabwe and Bangladesh. Funds are being used to raise awareness and to provide access to sexual and reproductive health information and family planning supplies and to improve maternal health.

In passing I should note that a few questions have been thrown into the pot in the last year or so relating to MSI’s work in developing countries, such as:

Asked by Lord Alton of Liverpool (inevitably)

To ask Her Majesty’s Government how many abortions performed in countries overseas were paid for by (a) the Government, and (b) organisations funded by the Government, in each of the last five years, by country; and whether any restrictions were placed on the performance of those abortions. [HL5847]

Baroness Verma: The information requested is not available without incurring disproportionate cost.

The Department for International Development (DfID) does not support abortion as a method of family planning. We believe the best way to eliminate unsafe abortion is to provide access to family planning information, services and supplies and to ensure that women have more control over the circumstances in which they have sex. In countries where abortion is permitted, DfID will support programmes that make abortion safe and accessible.

I think we can all see where this is going…

In the House of Lords, 14 June appears to have been Groundhog Day…

Asked by Lord Alton of Liverpool

To ask Her Majesty’s Government what was the cost to the National Health Service of providing abortions in (a) NHS hospitals, and (b) approved independent sector places in 2010.[HL9673]

Earl Howe: The total cost to National Health Service providers (NHS trusts and primary care trust (PCT) provider arms) of providing abortion services in 2009-10 was £82.6 million.

Information on the cost of abortions performed by the independent sector, which were commissioned directly by PCT commissioners, is not collected centrally. However, the department does collect the cost to NHS providers (NHS trusts, foundation trusts and PCT provider arms) of commissioning or contracting abortions from independent sector providers. The cost of this in 2009-10 was £7.5 million.

And finally (thank fuck) on 29 June this year and a little under a month shy of three years on from the start of all this, Alton gets around to asking:

Asked by Lord Alton of Liverpool (no shit Sherlock)

To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 14 June (WA 168)?, why information on the cost of abortions performed by the independent sector, commissioned directly by primary care trust commissioners, is not collected centrally; whether they will now ask for this information; and how many such abortions were undertaken in 2009-10.[HL10234]

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): Reference cost data are currently collected from National Health Service provider organisations (NHS foundation trusts, NHS trusts and primary care trust provider arms) and show the costs they incur in providing services to patients. This covers both the services that they themselves provide and services they contract out to independent sector organisations.

The cost to primary care trust commissioners of commissioning services from the independent sector for services such as abortion is not currently an explicit requirement of the reference cost collection. Any requirement to collect these data in the future would be subject to the department’s review of central returns process. This is intended to ensure that central collections of information are appropriate to their purpose, do not duplicate existing collections, and minimise the burden on the NHS of submitting the data.

There were 189,100 abortions performed on women resident in England and Wales in 2009 and 189,574 in 2010. Of the 189,574, over half, 59 per cent, took place in the independent sector under NHS contract.

So that’s the full story – erroneous information has been given in response to parliamentary questions on some occasions, but then corrections have been made where this has happened. However, on the central point that Alton and others have been chasing, i.e. the cost to the NHS of the abortion services that are contracted out to independent providers, the government’s position has been entirely consistent throughout this entire three year period – those figures were not available because they weren’t collated centrally and at no point has the government ever suggested otherwise.

Now you can argue that the government could, and should, have asked PCT’s to include these figures in their central cost returns, but it didn’t and, as a result, Alton and others have been clearly advised on no less than eleven occasions in the last three years that figures for the direct costs of commissioned abortion services were not available and not included in any of the figures that they were given during this period.

And if that weren’t obvious enough, every single year the Department of Health publishes it annual abortion statistics, which give a clear breakdown of the number of abortions carried out by type of provider, i.e NHS, Independent Sector under NHS contract and Private Funded.

So – when you’re told that the NHS spends £83 million a year on terminations, excluding any figures for independent sector contracts, and the official statistics are also telling you that the independent sector carries out more than 100,000 abortion a year, compare to 70,000 or so carried out by the NHS then it doesn’t take a genuine, or a professional mathematician, to figure out that there’s a big chunk of money somewhere that hasn’t been fully account for in the figures you’ve been given, even if this simple observation seems to have been beyond the ken of a member of the House of Lords (since 1997) with 18 years prior experience as a member of the House of Commons.

Thirty-two years in the House, can’t read your own correspondence or do basic maths – no wonder the country’s going to shit.

Getting back to the Telegraph’s article, Alton continues by adding:

“The millions of pounds generated by the private abortion industry, which have never been revealed to Parliament, demonstrate why Frank Field has been absolutely right in demanding that the multi-million pound link between the referral agencies and the abortion industry should be severed.”

No it doesn’t – all it actually demonstrates is that there’s a cost attached to providing abortions, as there is with any other NHS service. Claims that this shows that independent sector abortion providers have been operating under a conflict of interest are nothing more than unevidenced innuendo – there is absolutely no evidence whatsoever to show that independent sector providers have been acting unethicially and directly seeking influence women’s choices about abortion in order to boost revenues.

Moving on, The Telegraph gets is next statement completely wrong…

Under the previous method of collecting data, the Department of Health estimated a total of £90m was spent on abortions in 2009-10. Of this, just £8m went to independent providers such as Marie Stopes International and the British Pregnancy Advisory Service, with the rest being paid to NHS organisations.

No – if you look at the correction issued in October 2010 and the answer given to Alton in June 2011 then its perfectly clear that the £8m that the Telegraph claims ‘went to independent providers’ didn’t go to those providers at all. What this figure is, is the total cost to the NHS of the bureaucracy involved in commissioning these services from independent providers, part of the NHS’s own management and administration costs and not a payment to an outside organisation for services rendered. The direct cost of providing abortion services via contracts with independent sector providers has never been included in any of the figures given over the last three years, a fact that the government have acknowledge on every single occasion they’ve been asked for this data.

But in a letter to Lord Alton, the health minister in the House of Lords has admitted that “concerns” have been raised about these calculations, partly because organisations have interpreted guidance on collecting costs in different ways.

Earl Howe wrote that the Department’s method of calculating costs is “less reliable” than the figures on abortions provided directly to the Chief Medical Officer by law, which in future will provide the basis for the statistics.

Quite, although – based on the information that has been disclosed over the last three years, by far the biggest source of confounding in these figures stems from the NHS failing to differentiate between the costs incurred by NHS hospitals performing elective abortions and those incurred when performing non-elective abortion, i.e. when women miscarry or are unfortunate enough to discover that their foetus has died in the womb.

This bring us neatly on to the new figures that the DoH have given Alton, figures which – as quoted by the Telegraph – appear to raised rather more questions than they actually provide concrete answers.

Under the updated figures, taxpayers spent £118m on abortions in 2010, of which £75m went to private clinics and just £44m to NHS bodies.

The total number of terminations carried out in England rises from 136,000 to 173,000 and the cost of each one from £660 to £680 under the revised figures.

For starters, the figures given for the total number of terminations carried out in England (£173,000) don’t tally with the official abortion statistics, which are based on returns to the DoH via the Chief Medical Officer. According to the latter set of statistics, the total number of elective abortions carried out in England in 2010 was 196,109, although only 189,574* were carried out for people who are ordinarily resident in England and, therefore, eligible for NHS funding. This discrepancy well may stem from nothing more than a calendrical mismatch; the official abortion statistics are based on figures for the calendar year (Jan-Dec), while costs are calculated in line with the financial year (Apr-Mar) but there is nevertheless a discrepancy in the figure that needs to be explained and accounted for.

*Of these, 8,270 funded their abortion privately, leaving a balance of 181,304 NHS funded abortions in total.

In these new figures, direct NHS costs fall from £82-83 million down to £44 million and, based on information given previous, this seems likely to be the result of excluding the costs of non-elective terminations from the figures. That said, previous figures for direct NHS costs have been based solely on admissions to NHS hospitals for the actual procedure and did not include the cost of GP consultations prior to referral.

The average cost to the NHS of a standard GP consultation (6 minutes) has been estimated at £32 and so, with the NHS having carried out 69,259 abortions in 2010, there should be at least another £2.2 million in GP consultations to be added to the figures for direct NHS costs although the actual costs are likely to be significantly higher as 6 minutes is anything but sufficient time for a pre-abortion consultation. By comparison, a pre-abortion consulation with an independent provider costs between £65 and £80 and can last for around an hour.

The £75 million figure for ‘private clinics’ also looks rather questionable in terms of accuracy.

In 2010, the NHS funded 111,755 abortions via contracts with independent sector providers, the vast majority of which were undertaken by either BPAS or Marie Stopes International – according to BPAS’s last set of published accounts, the organisation performed around 52,000 abortion in 2009/10 while, in MSI’s case, the most recent figures we have (2009) suggest that the organisation may have carried out anything up to 54,000 NHS funded abortions during that year.

Now here’s where things get interesting.

There are currently no detailed figures for MSI’s income from the provision of abortion services in the UK. MSI is global organisation and does not provide a country by country breakdown of its income from service contracts in its annual accounts nor it differentiate between income derived from abortion service and and income derived from other reproductive health services, i.e. pregnancy tests, contraceptive services, vasectomies and sterilisation, STD testing, etc.

BPAS, similarly, down not provide a breakdown of its income by type of service but it only operates in the UK and it does publish figures for its total income from service contracts in its annual accounts – for the financial year 2009/10 the figure was £25 million and in this same year it carried out 52,000 abortions, most of which were NHS funded*.

*BPAS’s account do not indicate how many privately funded abortions it carried out during this, or any other year, but the numbers are likely to be small as privately funded abortions account for only 10% of the total number of abortions carried out in England, including women travelling from overseas to the UK to access abortion services.

If we look at this is very simple terms, BPAS’s 52,000 abortions gives it just over a 41% share of the total demand for abortions in England that isn’t met directly by the NHS, including all privately funded abortions, and in 2009-10 this was worth £25 million in revenues. If we assume that BPAS’s fees are typical of the sector as a whole – which is entirely reasonable as costs for NHS contracts are pegged to central tariffs – then we can estimate the total value of the independent sector ‘market’ at around £61 million in 2009/10, £14 million less than the £75 million figure given to Lord Alton.

And we have another discrepancy that needs to be explained, although one possible answer – and maybe even the likely answer – is that the figure given to Lord Alton is for the total value of NHS payments to BPAS, MSI and other independent abortion service providers and doesn’t, therefore, differentiate between payments for abortion related services and payments for other reproductive health services, a field in which MSI is a much bigger player than BPAS.

So, it seems that the figure given for direct NHS costs may well underestimate the true costs by excluding the cost of GP consultations while the figures for the independent sector don’t seem to add up and may overestimate payments for abortion-related services by failing to separate these out from other reproductive health services provided by the same organisations.

So, in all this, has Parliament been misled?

No – the figures given may be far from perfect and errors have crept in to reporting on a couple of occasions but at no point has David Alton, or anyone else, been given misleading information about NHS payments to independent sector abortion providers for the simple reason that, at every time of asking, the government have been clear is stating, for and on the record, that those figures were not included in any of the data given to Members of Parliament.

If Alton wants to complain that these figures weren’t being collected by the Department of Health then that’s fair enough – the government should be keeping on top of public expenditure, especially when it comes to outsourced contracts – but to suggest that parliament has been misled is nothing more than a pile of bullshit.

As this is the Telegraph, the last word goes – unfortunately – to the Member of Parliament for Mid-Narnia:

In September, the Conservative backbencher Nadine Dorries tabled an amendment to the Health and Social Care Bill that would have meant all women considering ending a pregnancy were given advice independent of the abortion provider.

The proposal was defeated but the Department of Health has said it will consult on the “best” form of counselling.

Mrs Dorries said it was a “huge concern” that incorrect figures had been in circulation for so long.

She added: “If anything proves that the link between the abortion provider and the woman facing a crisis pregnancy should be broken, this is it – too much money changes hands for anyone to argue that the private abortion provider can remain objective during the decision-making process.”

There are three generally accepted standards of proof; absolute proof, proof beyond reasonable doubt and the weakest standard, proof by balance of probabilities. What Dorries routinely fails to appreciate is none of the standards include proof by innuendo and personal prejudice, the only standard that she seems to recognise, largely because she has no actual evidence to support any of her arguments.

Still, as Dorries is so concerned about the possibility of non-NHS service providers acting on conflicts of interest driven by financial considerations, I’ll look forward to seeing her argue the same concerns in relation to the government’s current NHS reforms which, of course, promise to introduce even more ‘conflicts of interest’ of just this variety into the NHS.

No?

You think I’ll be disappointed…?

Of course not… I’m not that fucking stupid.