Dorries and BPAS – a Pre-emptive Fact Check

Tonight I’m going to try something that’s a little off the wall even by my standards – I’m going to pre-emptively fact check a ‘report’ before its even been released into the public domain and without having any advanced sight of its contents.

How, I guess your wondering, am I going to manage that feat?

Well, truth be told, its not as if I have nothing at all to go on.

This so-called report has been produced by Nadine Dorries’s ‘Right To Know’ campaign, from which we can safely assume that we’ll be dealing with a thoroughly dishonest piece of propaganda, and as The Telegraph has published some information about its contents its not difficult to track down the source information used in the ‘report’ and – from that – make a few educated guesses as to how Dorries and her Christian fundementalist backers will have gone about twisting and misrepresenting the information to suit their own ends.

In one sense, therefore, this article is not just a fact check, its a guide to what you should looking for if you read Dorries’s report in order to identify exactly where and how she’s misusing and abusing information that’s already in the public domain to promote her campaign by smearing her opponents, and in particular, the British Pregnancy Advisory Service.

So, lets look (via IstyOsty) at the relevant section of the Telegraph article, which was published on Saturday 2 June 2011.

The proposals emerged as campaigners for changes to abortion law publish a report accusing clinics funded by the NHS of using “hard sell” tactics to pressure women into having abortions.

The report by lobby group Right To Know attacks major abortion providers for recruiting business development managers who are asked to promote the growth of the businesses, and generate increased income.

It quotes financial statements from abortion provider bpas which list increases in the number of terminations as significant goals achieved.

The group is campaigning for an amendment to the health and social care bill, now going through parliament, proposed by MPs Nadine Dorries and Frank Field so, that all women considering abortion are offered counselling by independent organisations – not by a clinic providing the termination.

Their report, published tomorrow, says that organisations like bpas, which combine counselling with a medical assessment, to find out which method of abortion is suitable, put pressure on women to go ahead with a termination.

Mrs Dorries said: “Ultimately the woman should have the right to make her own choice, but often they are not given all the information they should be given regarding the abortion process.

“The marketing techniques are so slick that many women are coming out of the process feeling as though they were rushed through it and given no choice.”

First prediction – the ‘report’ will NOT contain any hard evidence of BPAS using ‘hard sell tactics’ or ‘slick marketing techniques’ to pressure women into having abortions.

It may well include a number of anecdotes which do make allegations of this kind the likely source of which will be women associated with the ‘Forsaken’ book and non-charity that Dorries started promoting late last year. As regards the reliability of these anecdotes, I could – I suppose – point everyone in the direct of any number of detailed academic studies on the general unreliability of human memory, an issue that has been extensively studied over the last 30 years or so.

However, on this occasion, my point can be made just as easily by reminding everyone of what Nadine Dorries had to say about the book when she promoted it – on the public record – in a parliamentary debate:

…I shall finish by mentioning a book which is to be launched this month. It is published by the charity Forsaken, which is neither pro-life nor pro-choice: it is pro-women. For two years, the charity has put together the stories of women suffering from post-abortion syndrome. Reading the book is so heart-wrenching that we just want to reach out and take their pain away, but we cannot. There is no going back. We cannot make it better; abortion is a procedure to end life-it is final.

And then contrast that with the assessment of the same book by Richard Bartholomew who, for my money, is near an unimpeachable source as you’ll find anywhere in the British blogosphere:

Having seen the book, there is no way that it can be described as ”neither pro-life nor pro-choice” – it is blatantly anti-abortion, with two very obvious aims: (a) to make women contemplating abortion feel that they shouldn’t do it; and (b) to persuade women who have had abortions to convert to Christianity. The stories abound with sentences such as “As I prayed, I felt a weight lifted from me”… “I had a new calling in my life – God”… “My son is in the arms of God”… “God has forgiven me, that’s his promise to us all”… “Tears of joy rolled down my cheeks as I realised that they forgave me and so did Jesus”. Interspersed are poems, including one in which a fetus remarks on how the womb is “so wonderfully designed by my Creator”.

Based on that, I think it safe to say that any anecdotal claims in the ‘report’ can be readily dismissed as lacking in objectivity unless they come with independent corroboration – and the chances of Dorries being able to produce any such corroborating evidence are, to say the least, extremely slim.

To drive home the point about the lack of any concrete evidence of unethical conduct on BPAS’s part, the organisation has a clinic/consultation centre in Cardiff which is subject to periodic, unannounced inspections by the Healthcare Inspectorate Wales under the provisions of the Care Standards Act 2000. A search on the HIW website turns up three inspection reports, the earliest of which dates to 2007, and this first inspection uncovered one or two minor issues with the quality of information and support provided by the centre in regards to minors (13-15 years olds) making use of its services:

The atmosphere is friendly and professional, putting patients at ease and respecting their privacy and dignity. Counselling is provided and informed consent obtained before any treatment is undertaken. The ‘patient’s journey’ is assisted with clear information on the BPAS computer website, which is comprehensive and well written leaflets.

However, the print/font is small and there is no indication on the leaflet of where to obtain information if there are communication or language difficulties. Appropriate policies and procedures are in place and Health and Safety Issues are monitored. There is no specific ‘Transfer of Children Policy’ and one must be established and the Algorithm clearly displayed to inform staff of what action to take if a child becomes ill or injured at the centre. Staff must be appropriately trained in resuscitation techniques.

You may well note one very important statement in there which runs entirely contrary to claims made by Dorries:

Counselling is provided and informed consent obtained before any treatment is undertaken.

The lack of a ‘Transfer of Children’ policy cropped up because, at the time, the clinic/centre, which appears to have opened only shortly before the inspection was undertaken, was not yet licensed to provide early medical abortions, which use an ‘abortion pill’ and take place before 9 weeks gestation, to under 16s. Any minors seeking an abortion had, therefore, to be directed to BPAS clinics in either Birmingham or London, which could expose a minor to additional risks, hence the need for this policy.

The inspection report goes on at add that:

Some of these may be alleviated should the service be more locally available. In view of this information, the inspection was carried out using a ‘Child and Young Person’s’ perspective, particularly observing for the physical and psychological impact made on this age group as users of the service. The Child’s ‘patient journey’ could be enhanced by the provision of specific, age and language appropriate patient information, including a wider range of sexual health and health promotion information.

In short, the inspection was conducted specifically with a view to assessing the centre from a young person’s perspective in anticipation of an application for a license to provide a service to minors at the clinic/centre. The inspection report then adds:

The Consent Procedure is taken very seriously with Risks to Patients clearly identified in the Patient Information Leaflets and reinforced verbally at both the counselling and consultation sessions. It would be beneficial to the children’s understanding of the Consent Procedure and the Consent Form if an explanation was given of the term ‘Fraser Competent’ cited on the Consent Form. The members of staff have knowledge of Child Protection Procedures and Young People’s Health Issues; this can be further strengthened by mandatory training and formally liasing and linking with the Area Child Protection Nurse and The Children’s Commissioner’s Office.

Again, some small room for improvement was identified but otherwise, the Inspectorate found that:

The Consent Procedure is taken very seriously with ‘Risks to Patients’ clearly identified in the Patient Information Leaflets and reinforced verbally at both the counselling and consultation sessions. The Consent Form includes the good practice point of ensuring a space on the form for the signature of an interpreter’s and parent. Written consent is obtained prior to treatment and it is the stated policy/procedure of the centre to spend sufficient/dedicated time with the patients to ensure that they understand the information provided. Dedicated time is also allocated post treatment. This is noted and commended as good practice. Detailed and comprehensive pre and post treatment information is available and given to patients. This is noted and commended.

And…

The consultation rooms, at the centre are conducive to private confidential discussions. Chaperoning arrangements are in place if required.

I doubt very much that you’ll find any of this kind of information on BPAS’s services in Dorries’s report, least of all because a follow-up inspection the following year (2008 – and again unannounced) shows that almost all of the previous year’s recommendations had been addressed in full but for the ‘Transfer of Children Policy’ which was proving a little awkward to put together. The 2008 inspection report generated a few new recommendations, which the centre addressed (see the end of the report) and by the time the centre was inspected again, in August 2009, it was given a clean bill of health on every single care standard on which it was assessed.

In addition to being licensed and regulated by the Department of Health and, in Wales, by the HIW, BPAS is – since 2009 – a member of of Independent Healthcare Advisory Services (IHAS) and subject to the Independent Sector Complaints Adjudication Service (ISCAS), and although the ISCAS annual report does not provide any information about exactly which of its members were subject to complaints, the fact that the only complaint it received in 2010 which related to an ‘Allied Health’ profession was rejected seems to suggest that it received no valids complaints whatsoever about the abortion counselling services provided BPAS and Marie Stopes International, which is also an IHAS/ISCAS member.

Moving on, the Telegraph notes that:

The report by lobby group Right To Know attacks major abortion providers for recruiting business development managers who are asked to promote the growth of the businesses, and generate increased income.

This is no great secret, in fact you can view the job description and person specification for this role within BPAS in this pdf document, which comes directly from the BPAS’s own website and it does, indeed, include the following statements:

JOB PURPOSE

To actively source and develop new business (private and NHS) while sustaining the existing caseload

And…

1. To promote the growth of business and income generation in the region.

1.1. To develop and implement an agreed programme of activity targeted at gaining new business in line with the BPAS business plan.

And there’s quite a bit more besides which – if you’re mounting a dishonest ideologically-driven anti-abortion campaign – can be readily twisted and misrepresented to create a false picture of a venal organisation on the make.

However, there are a couple of points of fact that are unlikely to feature in Dorries’s report.

One is that the BPAS don’t just provide abortions – they also provide a wide range of other services including contraceptive advice and provision, vasectomies and STI testing, including HIV testing, so there’s plenty of scope for bringing in new business without necessarily focussing on abortion.

The second and most obvious point is to be found in the person specification in which one of the desirable qualities that the BPAS was looking for when recruiting a business development manager was:

Knowledge of NHS commissioning policies

In simple terms, if you are going to create or operate a competitive B2B (Business to Business) market in healthcare services within the NHS, which is – even allowing for the recent climbdown – Coalition policy, then healthcare service providers such as BPAS are going to have to gear up to compete within that market for NHS contracts.

Dorries is personally on very shaky ground in trying to use this particular line of attack. After all, in April this year she had this to say – on her own pseudoblog – on the subject of her own party’s NHS reforms:

Many Conservative MPs, me included, are passionate about the reforms and will be slightly less than pleased should they begin to be watered down. I am personally delighted that we are continuing the process introduced by Labour, to allow even more NHS services to be contracted out to the private sector. If the private sector can offer the best quality service at the right tariff, why should patients be subjected to an inferior service for the sake of a mis-placed political ideology? If the private sector isn’t allowed to ‘cherry pick’ the services they provide, why not?

By her own reasoning – a term I use in its broadest possible sense – if BPAS can offer the best quality abortion services at the right tariff then why should women be subjected to an inferior service for the sake of a misplaced religious ideology?

Why should BPAS be subject to criticism for responding to the kind of NHS reforms that Dorries quite obviously favours by appointing regional business development managers with a brief that asks them to go out there and compete for NHS abortion service contracts?

Based on the figures for 2010, the NHS funds 96.7% of the abortions carried out in England and Wales of which 58.6% are carried out by the independent sector, which includes BPAS, with 36.7% of abortions still being carried out in NHS hospitals. So, there’s clearly plenty of scope there for BPAS to grow its ‘business’ – remember its a charity – simply by competing for existing NHS contracts and increasing its market share even if the annual number of abortions falls. If recruiting a business development manager means putting the ‘hard sell’ on anyone then the obvious target for a bit of slick marketing, under the coalition’s NHS reforms, will be the new GP commissioning bodies and not women who may be considering an abortion.

According to the Telegraph, Dorries’s report will also:

…quotes financial statements from abortion provider bpas which list increases in the number of terminations as significant goals achieved.

Fortunately, as BPAS is a registered charity its financial statements to the Charity Commission are public documents and so, from its most recent set of accounts, we find that what it actually said in its accounts was:

Goal 2: Partnership with the NHS extended and bpas services to be more attractive and accessible to Commissioners and individual clients

Significant achievements in 2009-2o10 were:

– Collaborative partnerships with commissioning organisations and those responsible for thelr strategic input into the national framework, such as Department of HeaIth, the Government’s lndependent Advisory Group on Sexual Health & HIV, NFIS London and MedFASH (the medical foundation for sexual health and HIV)

– lnvolvement in the development of a mandatory service specification for the commissioning of abortion services which is in line with bpas quality standards, and in the development of a strategy for pan-London commissioning.

– The attainment 0f an additional 2,400 NHS procedures in calendar year 2009 compared to 2008.

– An increase of more than 3,000 procedures at less than 9 weeks gestation in calendar year 2009 compared to 2008.

– The development and implementation of a new-media marketing strategy including email campaigns and the launch of a website aimed at potential clients from the Irish Republic.

Again, there’s plenty of scope there for misrepresentation which Dorries will likely have taken up and so there’s a few factual points that need to be addressed which you’re unlikely to find in her ‘report’.

The ‘hot ticket’ item for Dorries will undoubtedly be the reference to…

The attainment 0f an additional 2,400 NHS procedures in calendar year 2009 compared to 2008.

But to put that in context, in 2009 there was a 3.2% fall in the number of NHS funded abortions carried out in England and Wales compared to 2008, a drop of just over 6,100 abortions. So all this line item actually tells us is that BPAS probably managed to pick up one or two additional NHS contracts over the year.

From its accounts, BPAS income increased by £863,000 over the previous year and if that entire increase was due to the rise in NHS procedures that would indicate that it was making around £360 per procedure when the standard NHS tariff for medical abortion is £502 per abortion. Indeed, as I pointed out over at Liberal Conspiracy last November, whatever BPAS actually charges the NHS for its services, its actually less than the NHS’s own internal tariffs for abortions.

Then there’s the statement that:

An increase of more than 3,000 procedures at less than 9 weeks gestation in calendar year 2009 compared to 2008.

Good for them – the relevant point here is that there are fewer risks associated with early abortions carried out before nine weeks gestation than there are with second trimester abortions and so, from a purely clinical perspective, if you’re going to have legal abortions then its best all around that as many as possible are conducted before nine weeks gestation, when the risks of complications are at their lowest.

Then there’s also this…

The development and implementation of a new-media marketing strategy including email campaigns and the launch of a website aimed at potential clients from the Irish Republic.

Of course, a website for potential clients from the Irish Republic would be entirely unnecessary were the country to join the 21st century and legalise abortion but its nevertheless worth noting both that the Irish Republic accounts for around two thirds of abortions undertaken by non-residents and that this is around a fifth of the number of non-resident abortions than during the peak years of 1982/83 when more than 34,000 women were forced to travel to the UK to obtain a safe, legal abortion – at their own expense, of course – because they couldn’t obtain such a service in their home country.

As for the new media marketing strategy and email campaigns, its quit easy to see what BPAS are providing, and to whom, as this is also readily available online via their website in the form of a resource toolkit which promotes its range of advice and information leaflets, referral forms. gestation calculators, etc. – all materials that are aimed primarily at GPs and other healthcare, advice and information providers. Oh, and while were on the subject of ‘marketing’ if you look closely at the leaflets on page 3 of the PDF document (by zooming in) you’ll see that we can readily off another of Dorries’s favourite myths as the top leaflet is called ‘Unplanned Pregnancy, Your Choices’, the text of which includes the following statement:

If you have confirmed you are pregnant, then you have three options open to you:

1. Continue the pregnancy and place the baby for adoption or fostering

2. Continue the pregnancy and become a parent

3. End the pregnancy with abortion, if you are legally able to do so

So much for not making women aware of that fact that adoption is an option, in fact you can see the entire contents of this leaflet on the BPAS website and you’ll see that it also provides contact information for both the National Childbirth Trust and a couple of adoption/fostering organisations.

That just leaves us with the allegation that women are:

often they are not given all the information they should be given regarding the abortion process.

Again, I doubt very much that Dorries has any concrete evidence of this beyond recycling anecdotes from Forsaken and/or other anti-abortion organisations but, in any case, the issue here is not that BPAS aren’t giving women all the information they need but rather that what they don’t give women the kind of unsound, biased and unscientific ‘information’ that Dorries and other anti-abortionist routinely peddle, and issue I’ve dealt with on numerous occasions over the last 3-4 years including the following reasonably recent posts.

Women have a right to know
Dorries’ Abortion Risk ‘Plethora’
Does Dorries know whose ‘research’ she’s promoting?
Colemanballs – a study in bad abortion science
Mad Mel, Abortion and the Liars for Jeebus Club
Dorries’ amendments blown apart by RCPsych review

And, course, no discussion of Dorries’s extremely casual relationship with factual evidence would be complete without a link to an account of the infamous ‘Hand of Hope’ incident.

That’s your lot for now – I guess we’ll see how good my powers of prediction are in the morning but if you get to Dorries’ report before I do then please use the material here to check it out for yourself.