Right To Know? More like ‘Right to Bullshit’.

We’ve had to wait a little longer than expected for the publication of the Right To Know campaign’s ‘report’ on a so-called marketing of abortion services by the British Pregnancy Advisory Service, largely, I suspect, due to nation’s ongoing obsession with the fall of the House of Murdoch, but the report is finally here (pdf) and, yes, it is everything I expected it be – dishonest, misleading and full to brim with distortions, quote-mining and assorted other tendentious bullshit.

In short, everything I’ve come to expect from my own experience of dealing with anti-abortion campaigners.

A couple of weeks ago, and based on a single report in the Telegraph, I made a few predictions as to the likely content of this report, and sure enough, I correctly predicted that Dorries’ campaign would try to make a meal out of a job description, obtained from the BPAS website, for a post of Business Development Manager.As is transpires, Marie Stopes International comes in for much the same treatment, with report citing this section of a job description for an Business Development and NHS Contracts Manager with the organisation.

In the case of both organisation, the role of ‘Business Development Manager’ relates specifically to thr management, acquisation and expansion of NHS contracts, NOT the direct marketing of abortion services to the general public.

What this report doesn’t mention is that in 2010, 69,529 abortions were carried out in NHS hospitals in England and Wales. In many cases, this will have meant that women undergoing a termination will have been required to attend an Ob-Gyn unit which is situated in the same building as the hospital’s maternity unit, i.e. the same building in which other women are delivering their full-term babies, rather than a discrete private clinic, as is the case where abortion services are contracted out to an independent provider. Anyone with the slightest concern for the wellbeing of women who do choose to have an abortion will see immediately that there is something very wrong with the practice of admitting those women to a unit in which, at the same time, other women are giving birth, undergoing ante-natal screening and check-ups and even, in some cases, receiving IVF treatment. It is just not a civilised or humane practice at all and, in many – but not all areas – its a practice that the NHS successfully avoids by contracting out the overwhelming majority* of their abortion services to BPAS, Marie Stopes International or to another independent provider.

*Even in areas served by an independent provider, NHS hospitals will still carry out a small number of abortions, typically late-term abortions occurring after 16-20 weeks gestation and often for reasons of foetal abnormality.

Don’t just take my word for this either – here’s Earl Howe, a Conservative health minister, confirming how the NHS commissioning system works in relation to abortion services in March this year, in response to a question tabled by Lord Alton:

Lord Alton of Liverpool (Crossbench)

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.

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

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; and the quality of abortion provision and wider sexual health provision more generally.

Moreover, and as this parliamentary answer indicates, neither organisation is solely in the business of providing abortion services – both provide a range of other sexual and reproductive health services, including contraceptive services, pregnancy testing, screening for sexually transmited infections and, in BPAS’s cases, vasectomies. These are services that the NHS can, and does, provide but which can also, in some areas, be partially contracted out to the independent sector or, indeed, accessed privately.

In short, there is considerable scope for organisations like BPAS and Marie Stopes to expand their services and increase their revenues by competing for and securing contracts for services that, in many areas, are still provided exclusively by the NHS.

This is, in fact, precisely what the present government, i.e. Nadine Dorries’ own political party, wants. One of main purposes of its Health and Social Care Bill, as its was introduced to the House of Commons, is that of increasing competition in the provision of healthcare within the NHS by permitting private sector healthcare suppliers to compete with NHS hospitals for service contracts with the new GP commission organisations which will replace the existing Primary Care Trusts. Dorries not only supports this bill, which has – of course – been rather watered down of late following concerned opposition to many of its proposals from within the NHS, particular amongst doctors and nursing staff, but is on record as making statements which indicate that she would like to see the government go much further than the government had actually planned:

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?

And if the independent sector 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 Dorries’ religious ideology?

As we’re in the general area of ‘following the money’, its perhaps the right time to deal with the following claim, which appears on page 4 of the report:

In 2010 over 100,000 NHS-funded abortions were outsourced to private providers such as Marie Stopes International (MSI) and the British Pregnancy Advisory Service (BPAS), worth an estimated £60m.

No source is given for this estimate which is, in any case, demonstrably inaccurate.

A written question in the House of Lords, tabled by Lord Alton (again)  in June this year, indicates the actual costs to the NHS of providing abortion services, including services contracted out to independent providers:

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.

For £82.6 million, the NHS covered the cost of a little over 189,000 abortions in 2009/10 – I can’t give an exact figure at the moment as abortion statistics are collated on a standard calendar year (i.e. Jan to Dec), which financial data is given using the April to March tax/financial year. What we can say, however, is that the independent sector accounted for around 59% of the abortions carried out in 2009/10, which gives us a base estimate of the size of this sector’s share of the abortion ‘market’ of £48.7 million, NOT the £60 million estimate given in the report.

Taking this argument a stage further, BPAS and Marie Stopes International, the two largest independent sector providers in England and Wales, account for around 90% of all abortions carried out by the independent sector and, from the most recent published accounts, declared a combined income for services provided under NHS contracts of just under £39 million for 2009/10, which is around 80% of our base estimate for size of the independent sector’s ‘market share’ – i.e. around £4 million a year less than the revenues one would predict from our, rather more accurate, assessment of the size of the abortion ‘market’.

It would appear, therefore, that the independent sector provides the NHS with a much more cost effective range of abortion services than the NHS provides through its own hospitals, and to drive that point fully home, the basic NHS tariff for 2010 for a medical abortion, i.e. one carried out using an ‘abortion pill’ was £473. If we multiply that by 189,000 abortions to get an estimate for the total costs of abortion to the NHS if, all such procedures were carried out at the basic tariff, we get a figure of £89.4 million, almost £7 million more than the actual costs reported by the NHS for that year – and this doesn’t take into account the fact that 57% of the abortions carried out in 2010 were surgical abortions*, for which the NHS tariff for the year ranged from£564 to £662, depending on the exact procedure.

*If we adjust our estimates for the proportions of medical and surgical abortions then the estimated cost for abortions at NHS tariffs would be close to £100 million, around £17.5 million above the actual costs for the year. If the independent sector charged full NHS tariff rates, BPAS and MSI could easily increase their annual income by anything up to £10-£12 million a year.

Last, but by no means least for the ‘follow the money’ section, it has to be remembered that both BPAS and Marie Stopes International are registered charities and that any surplus income they generate is, therefore, ploughed back in to improving the facilities and services they provide to women. They are not profit-making private businesses and, unlike many of the private sector providers that Dorries would like to see crawling all over the NHS and competing for service contracts with NHS hospitals, they don’t any money out of the business to pay dividends to shareholders.

While we’re doing the numbers, I should also address the utter misleading ‘facts and figures’ given on page 2 of the report, as follows:

The changing role of private organisations in the provision of NHS-funded abortions for residents, in England and Wales.

 

In 1991 the NHS funded 9,197 abortions carried out by the private sector.

By 2010 that figure had risen to 111,775 – an increase of over 1100%.

 

In 1991 the NHS funded 10% of abortions carried out by the private sector.

By 2010 that figure had risen to 93%.

 

In 1991 the NHS funded 84,369 abortions.

By 2010 that figure had more than doubled to 181,304.

 

The growth of NHS-funded but privately-provided abortions entirely accounted for this increase.

Let’s rewrite those statements to reflect that true position; the one that Dorries’ and her mendacious ‘Right To Know’ campaign don’t want you to consider.

The changing role of private organisations in the provision of NHS-funded abortions for residents, in England and Wales.

In 1991 the NHS funded 9,197 abortions carried out by the private sector.

By 2010 that figure had risen to 111,775 – an increase of over 1100%.

In 1991, 70,861 women resident in the England and Wales has to pay the costs of an abortion out of their own pocket.

By 2010, that figure had fallen to just 1735.

 

In 1991 the NHS funded 10% of abortions carried out by the private sector.

By 2010 that figure had risen to 93%.

In 1991, 49.5% of women resident in England and Wales who needed an abortion had no option but to turn to the private sector and meet the cost out of their own pocket.

By 2010, only 0.9 of women resident in England and Wales had to pay for a private sector abortion – the remaining 6% came from oversea.

 

In 1991 the NHS funded 84,369 abortions.

By 2010 that figure had more than doubled to 181,304.

In 1991, there were 167,376 abortions carried out in England and Wales on women resident in England and Wales.

By 2010, this had risen to 189,574, an increase of 22,198 (13%)

In 1991, the independent/private sector carried out 80,058 abortions.

By 2001, this had risen to 113,150, an increase of 33,452.

The were 5,643 fewer abortions carried out by NHS Hospitals in 2010 than there were in 1991.

The were 74,737 fewer non-NHS funded abortions carried out in the independent/private sector in 2010 than there were in 1991.

 

The growth of NHS-funded but privately-provided abortions entirely accounted for this increase.

Because the NHS has changed the way it commissions abortion services since 1991, last year 101,106 women had the choice to have a safe, legal abortion in an independent clinic, funded by the NHS – a choice they would not have had in 1991.

In 1991, only 37% of abortions were carried out before 9 weeks gestation, when the risk of complications and other adverse effects on women’s health and wellbeing is at its lowest.

By 2010, 77% of abortions were carried out before 9 weeks gestation, when the risk of complications and other adverse effects on women’s health and wellbeing is at its lowest.

Anyone else get the impression that there are lot of things here that ‘Right To Know’ just don’t want women to know?

The dishonesty continues with what the report laughably calls an ‘analysis’ of the so-called marketing techniques used by BPAS and Marie Stopes International, a section which based entirely on quote-mining, misrepresentation and on assertions about alleged vested interests for which the Right To Know campaign have produced no supporting evidence for the simple reason that they have absolutely no supporting evidence to offer.

For example, the report states that:

MSI and BPAS are not able to provide independent counselling because they have a vested interest in abortions proceeding. Not only do they promote abortion services to Health Care Professionals but they also provide information to women considering abortion.

Well of course they do.

MSI and BPAS see women who are considering an abortion after they’ve either been referred into their services by a GP or when women self-refer by contacting one of these organisations directly and making an appointment to visit a pregnancy advice bureau. They key thing to understand here is that the women that BPAS and MSI are, at the very least, already considering an abortion before they work through the door and, in many, if not most, cases, they’ve already made their decision before speaking to anyone at either organisation.

Women do not contact these organisations about an abortion unless they are already considering having an abortion, and a big part of the information they’re looking for when they make contact is information about abortion.

And despite having an alleged ‘vested interest’ – and remember, there’s no actual evidence to support such an allegation – BPAS reports that 15-20% who visit their pregnancy advice bureaux to discuss the option of having an abortion choose not to go ahead with the procedure, which hardly seems to be evidence of them putting the hard sell on women, given that a large proportion of the women who are referred to them have already made their decision before they walk in the door and simply want to get through the formalities and make an appointment for the procedure itself.

The report goes on to state that:

The way in which BPAS combines counselling and the first medical steps in the abortion process is a striking example of the inevitable conflict that arises where an organisation is expected to provide advice relating to a service that it itself sells.

This quote from the BPAS website shows how counselling and medical assessment are confused:

“Counselling is part of the initial consultation at BPAS during which you will also have a medical screening so that we can asses your stage of pregnancy and medical history to find out which methods of abortion are most suitable for you.”

We believe that this confusion is inevitable where an organisation is involved in marketing a service and is an example of why such entities are inappropriate bodies to provide pre-abortion counselling funded by the NHS.

Combining counselling with the first medical steps for abortion puts pressure on women and trivialises the decision-making process. Women should be allowed time and space to make their decision and all the medical assessment for abortion should be kept separate from the counselling stages.

This is not just dishonest is it – if you’ll forgive the lapse into invective – plain fucking stupid.

The medical ‘screening’ that women receive on attending a BPAS pregnancy advice bureau serves the following purposes:

1. It establishes that women are actually pregnant – there is absolutely no point whatsoever in discussing an of the options for dealing with an unwanted or unexpected pregnancy unless there is actually a pregnancy to discuss.

2. It establishes the gestational age of the foetus, which is a critical piece of information as this determines both which abortion procedures can, and cannot, be used if the woman chooses to go ahead with a termination and, therefore, has a considerable bearing on both the risk of complications arising after the procedure and the type of complications about which a woman needs to be informed if they are to make a fully informed decision about whether to go ahead with a termination or opt for one of the alternatives, i.e. adoption or carrying the foetus to term and keeping the baby.

3. Women will also be asked questions about their own medical history, again for the express purpose of identifying whether this may indicate that there may be particular risks to their health and well-being that they should be made aware of before they come to a decision on whether to go ahead with a termination or not.

However, as the BPAS’s own guide to its services makes perfectly clear on pages 6 and 7, this screening take place only after a discussion on pregnancy options, in which both adoption and keeping the baby are address, has taken place and, of course, women are free to change their mind about having an abortion at any point right up to the point of the actual procedure. The ‘counselling’ element of the initial consultation is not actual combined with the screening; the discussion of pregnancy option takes place before any medical screening and women are free to walk away any point during or after the options discussion, after the screening, when they will have been advised on any risks/complications relevant to the procedure they may be considering or arising out their own medical history, or at any point up to the actual procedure itself – remembering that there’s generally a 3-5 wait between the initial consultation and the appointment at a clinic for the actual procedure.

The reports entire ‘analysis’ of the the information that BPAS provides is based on nothing more than deliberating twisting information intended to reassure women that abortion is medically safe procedure and presenting it, usually out of context, as if it were intended as an exercise in ‘soft marketing’.

If Dorries wishes to play that particular game then its worth noting that of the supposedly ‘independent’ organisations that she want to see women referred to, only Life openly states its doctrinal position on abortion on its website:

LIFE is opposed to abortion on principle in all circumstances because it ends the life of a unique unborn child.  This extends even to what many people consider the “hard cases”, such as disability, teenage pregnancy, and pregnancy after rape.  Some people raise the issue of “abortion to save the mother’s life”.  What they mean by this is that in a very small number of cases, a pregnant woman may have life-threatening health problems which can only be treated by doing something which may have the side effect of ending the pregnancy.  An example of this is chemotherapy, which can be an effective treatment against cancer but can also lead to the death of an unborn child.

In this situation, it is not really accurate to describe the action as an abortion, as the intention is not to end the life of the unborn child.  The child’s death is an unintended side effect.

CareConfidential, the other main provider of so-called ‘crisis pregnancy centres’, which has recently been floated off as a separate charitable entity from its parent charity, Christian Action Research and Education, makes no such statement on its website although, with a bit of luck, that may change in the near future as a result of complaint put forward to the Advertising Standards Authority.

And if its transparency you’re after – and this campaign is called ‘Right To Know’ – then I’ve yet to find any adoption service providers in the UK that provide information to preganant women on the often severe and long-term psychiatric consequences that some women suffer as a result of giving up a child for adoption, for all there is at least some research literature in this field which indicates that this is a far from easy process for some women.

But who cares, least of all the adoption provider? Once they’ve got a child to place with an adoptive family, why should they give a toss about what happens to the child’s natural mother?

I could go on – there’s more in the ‘report’ I could easily rip apart – but I think I’ve made my point. If there is a case to be made for more independent pre-abortion counselling then the starting point for such a case would begin with evidence to show both that there’s a demand for such counselling amongst women who are considering a termination and that BPAS and MSI have been acting on a conflict of interest and putting their own financial interests ahead of the interests of the women accessing their services.

Dorries’ campaign has failed, miserably, to produce any supporting evidence for either of these propositions because, and this cannot be stressed often enough, she has neither the evidence nor a single honest argument to support her position.

Before you get taken in by Nadine Dorries’ ‘Right To Know’ campaign, then ask yourself a few questions, or better still ask Dorries and her parliamentary buddy, Frank Field for answers to a few of these…

Why does this campaign put so much time and effort on publishing deliberately misleading and dishonest ‘information’ about BPAS and Marie Stopes International?

Why can it not produce any concrete evidence of either organisation acting on their supposed ‘conflict of interest’?

Where did the £60 million estimate given in the report come from, and why does it bear no relation to the actual figures presented earlier?

Why does the report omit any and all information about the changes in private sector abortion service provision since 1991?

Why has the campaign gone to considerable lengths to disguise the identify of the organisation(s) providing its website? Unsuccessfully, I might add?

Why did the campaign misrepresent its objectives when it contacted the British Association of Counselling and Psychotherapy in order to obtain a statement of support and why does it continue to claim ‘full support’ from BACP when, in fact, BACP have indicates that it will only support the provision of ‘independent counselling’ and has stated, for the record, that it ‘has never suggested or implied that organisations like BPAS and Marie Stopes International should stop providing abortion advice or any of their other ancillary services”?

Why does the campaign refer only to ‘counselling’ on its website and it press statements, when the amendment put forward in parliament refers to information, advice and counselling, and would this amendment not, hypothetically, prevent BPAS and MSI providing any information to women seeking an abortion, including information about the medical risks associated with the procedure?

Why, if you’ve called your campaign ‘Right To Know’ are there so many things that you clearly don’t want women – or anyone else – to know?

And, last but by no means least…

Why do you find it necessary to mislead the public in order to promote your campaign and why can’t you put up an honest argument for once?

Okay, so we all know the answer to that last question, its because they don’t have any honest argument to put forward – or at least none that would gain them any significant public support were they simply to tell the truth and engage in a open and honest debate on the substantive issues.

Oh, and you forgive me having a Columbo moment…

In view of everything set out here, is it not past time for your to change the name of your campaign to something that more accurately reflects your approach to this whole debate like, say, Right To Bullshit?