As one idiotic idea fades temporarily (?) into the background with the withdrawal of Nadine Dorries’ misconceived abstinence education bill from last Friday’s House of Commons order paper, another resurfaces in the form of proposals to alter the current framework for pre-abortion counselling which are, in part, a response to Dorries’ equally absurd and fundamentally dishonest ‘Right to Know’ campaign and her humiliating failure to force through legislative changes last year.

Before looking at the Department of Health’s efforts to throw Westminster Village’s resident idiot-in-chief a bone, we should quickly review Dorries’ excuse for Friday’s non-event. If she is to be believed – and that’s a hell of an ‘if’ given her well documented history of duplicity and bullshitting – she didn’t bother to have her Bill printed, at a suggested cost of around £800, in the belief that the bill’s scheduled position on the order paper (8th) made it unlikely that it would be debated, not realising that a failure to print the bill would result in its automatic removal from the order of business.

In short, Dorries has been an MP since 2005 and yet still claims not to know/understand basic House of Commons procedures which, when you think about, amount to nothing more than common sense, i.e. it should be obvious to everyone – except Dorries’ apparently – that MPs cannot possibly hold a substantive debate on the contents of a bill without first seeing the text of the bill.

In reality, of the forty-five private member’s bills on Friday’s order paper that were scheduled to be given their second reading, thirty-six were put to House and deferred to a later date – Friday 27th January – in a matter of ten minutes after a debate on the Daylight Saving Bill took up more or less the entire day. The remaining nine bills – not including Dorries’ bill – appear to have been pulled from the schedule at the last minute, and after the order paper was finalised, depriving the House of the opportunity to consider matters such as VAT relief for charitable healthcare providers, banning credit card companies from making customer payments to kiddie porn websites and the introduction of new criminal offence to deal with dangerous and reckless cycling = not that these would have got any more consideration than other thirty-six bills that were deferred.

Although Dorries has claimed that the bill hasn’t been withdrawn, she did also suggest that if and when it does resurface it may be as part of, or an amendment to, a different bill and not as bill in its own right, which suggests that its non-appearance on Friday may have much to do with her own abject failure to sneak it under the radar of its opponents as it does her own, self-professed, incompetence as an MP, although it should be remembered that Dorries’ is currently a member of the Chairman’s panel, a once-select group of experienced and highly respected backbench MPs from whom the chairmen/women of public bill committees are appointed, membership of which is now seemingly open to any low grade moron who can successfully crawl up the arse of the Speaker’s wife.

Getting back to the Department of Health and it proposals for altering the provision of pre-abortion counselling, and a more or less direct response to one of the most craven and dishonest campaigns in living memory, the options being put up for consultation are, according to the Telegraph:

The most radical change would see abortion clinics, such as those run by the British Pregnancy Advisory Service (BPAS) and Marie Stopes International, barred from providing counselling, and under a legal duty to refer women seeking it to an independent service – as had been laid out in Mrs Dorries’ amendment.

An second option is for a system of “voluntary registration”. This would would mean any organisation offering counselling to women with a crisis pregnancy would have to meet minimum standards, and only use appropriately-trained counsellors.

A cross-party group of 10 MPs which has held secret talks over the proposals has become deeply divided about whether organisations running such servicse should be required to declare any ethical stance – such as holding pro-life beliefs.

If that demand is made, some pro-life campaigners are likely to argue that abortion clinics would have to declare a financial interest in carrying out terminations.

A third option, to retain the current, is also detailed in the DoH policy paper, despite acknowledgement that it would mean a “postcode lottery” remained in the standard of care.

Without going into too much detail there are a couple of relevant points to be made, particular in relation to claims that the current system creates a postcode lottery in relation to standards of care.

Currently, abortion services are funded by NHS Primary Care Trusts with services contract either to NHS hospitals or to independent providers under outsourced/commissioned contracts which are managed by local trusts. Information, advice and counselling may also be either provided by the NHS or outsourced to independent Pregnancy Advice Bureaux or be made up a mix of provision from both sectors.

In some areas this means that most, if not all, NHS funded abortions take place in NHS hospitals while, in other areas, many, if not most, NHS funded abortions are undertaken by independent sector providers, which includes charities such as BPAS and Marie Stopes International, and private sector organisations of which the main players are Spire Healthcare, Nuffield Healthcare and BMI Healthcare.

In order to operate legally, both independent sector abortion providers and Pregnancy Advice Bureaux (PABx) have to be licensed by the Department of Health. Regulations covering the licensing of PABs currently run to 15 pages, from which we find that they are subject to regular inspections by the Department of Health and that these regulations explicitly cover the provision of counselling services, to whit:

A person trained and experienced in counselling in this field must be available to attend PABx if required. Counselling must be offered to women who request or who appear to need help in deciding on the management of pregnancy or who are having difficulty in coping emotionally. Counselling should be offered to women under 16 and to those with a history of psychiatric illness, who lack social or emotional support or whom their partner, family or employer is possibly coercing
into having an abortion. All staff must realise that a woman may not resolve ambivalence about a pregnancy during a counselling session. Rather, the session helps her clarify her thoughts and facilitates constructive discussion during the next few hours or days. This is often through more effective communication with her partner or some other person who is emotionally close. Women who remain ambivalent after counselling can be given a provisional appointment for admission but must be told that the procedure can be postponed or cancelled and that she remains free to continue with the pregnancy if, on reflection, she decides this would be the most satisfactory outcome.

Regulations covering the actual provision of terminations by clinics run to 28 pages and all licensed clinics in England are subject to regular spot inspections by  the Care Quality Commission while over the Welsh border the same responsibility falls to the Health Inspectorate Wales.

So, if there’s a postcode lottery in terms of care standards then at least some of the fault would seem to lie with the Department of Health, CQC/HIW and Primary Care Trusts, as these are collective responsible for the licensing and inspection of PABx and abortion clinics and for the commissioning, management and monitoring of abortion and other related services under NHS contracts. Moreover, under the current government’s proposed NHS reforms would see responsibility for abortion services transferred to local authorities as part of their new public health function, which could well make any existing ‘postcode lottery’ even worse.

Against this, we’re to be offered two alternatives; one which would bar BPAS and MSI from the provision of in-house counselling, with the risk that this could propel women into so-called Crisis Pregnancy Centres operated by anti-choice organisations, which is precisely what Dorries’ original bill was all about, the other would provide for a ‘voluntary registration’ system under which the provision of pre-abortion counselling would be restricted to counsellors who hold down a professional membership of a counselling organisation that’s accredited by the Professional Standards Authority, the creation of which is also part of the current government’s NHS reforms.

Although the voluntary registration option might sound like a reasonable compromise position on what is, otherwise, a fraught and hotly contested issue, things are not quite that straightforward; a previous attempt to bring counselling and psychotherapy under statutory regulation met with stiff resistance from practitioners who, one would argue, operate at or towards the quackery end of the sector. In terms of evidence-based practice the overall picture as it relates to talking therapies is, to say the least, rather mixed. There is some pretty good evidence for the efficacy some therapies in particular contexts, e.g. cognitive-behavioural therapy as a treatment for phobic disorders, but their remain large tracts of counselling and psychotherapeutic practice for which there is little credible evidence to support claims of efficacy other than the ubiquitous anecdotes and personal testimonials. A voluntary registration scheme, alone, is no guarantee of service quality and it remains to be seen what else, if anything, the DoH has to go with this option.

What we have here, in essence, are solutions to a problem that doesn’t exist – or rather one that exists only in the minds of a relatively small and unrepresentative minority with strong religious, moral and ideological objections to abortion in general; one that, when it runs its own pre-abortion services, frequently engages in poor practice and provides factually incorrect information.

Without ever intending to, at the outset, I’ve accumulated with a significant mass of research evidence and statistical information on the subject of abortion, and other related issues, not to mention a sizeable quantity of background information on the activities and propaganda output of anti-choice campaigners, and fully intend to being every single scrap of that information to bear on this particular consultation. Indeed, one thing the DoH can be assured of here is that this particular consultation will be watched and scrutinised very closely indeed in much the same manner used by disability campaigners in developing their successful Spartacus Report.

Game on.