Pre-signing of forms found in 14 out of 249 abortion clinics in England

BMJ 2012; 345 doi: (Published 13 July 2012) Cite this as: BMJ 2012;345:e4784
  1. Zosia Kmietowicz
  1. 1London

Fourteen abortion clinics in England have been told to stop pre-signing forms that authorise a termination after the health and social care watchdog inspected all 249 NHS and private providers.1 No evidence of poor outcomes was found at any of the clinics inspected by the Care Quality Commission.

Health secretary Andrew Lansley ordered the commission to inspect all abortion providers in England after it found in January that forms had been pre-signed by one doctor at a private clinic. This breaches the Abortion Act because, except in emergencies, two doctors must certify an abortion before it can take place. Although doctors do not need to see the woman they must review her medical notes to ensure that she meets the legal criteria for an abortion.

The request for the unannounced inspections was criticised by some observers because of the £1m (€1.2m; $1.5m) cost and because the commission had to abandon its other work, later found to be 580 inspections.2

Ann Furedi, chief executive of the British Pregnancy Advisory Service (BPAS), said Lansley’s motivation was “politically driven.” She added that it was “not absolutely clear that a pre-signed certificate would be a breach of the law” although it was “clearly not best practice.”

The inspections, which took place in March, found evidence of pre-signed HSA1 in 14 clinics, all of them NHS trusts. All of the providers have now stopped the practice “and steps including internal audits and staff training have been taken to ensure continued compliance,” said the commission.

In a statement the UK’s leading sexual health charities Brook and FPA said, “Although we are pleased that this set of inspections has confirmed that the vast majority of services are operating perfectly legally, we’re disappointed that such a time consuming, costly, and ultimately unnecessary process was instigated at all. It was a heavy-handed, knee-jerk reaction to concerns over what is in reality a heavily regulated process.

“We hope all women are now reassured that abortion services are safe and legal and will not be deterred from seeking advice if they need it.”

Diane Abbott, Labour’s shadow public health minister, said, “The CQC has blown Andrew Lansley’s weak justifications out of the water by confirming that no women had poor outcomes of care at any of the clinics that he personally ordered raids on. What is beginning to emerge from this report looks like a dark, sordid and politically charged campaign against care providers, doctors, and British women’s right to choose.”

The 14 hospitals where pre-signing had taken place were Bradford Royal Infirmary, Loughborough Hospital, Kings College Hospital NHS Foundation Trust, Royal Victoria Infirmary, Scunthorpe General Hospital, Rochdale Infirmary, Peterborough City Hospital, Princess Alexandra Hospital, Musgrove Park Hospital, Central Health Clinic, Leicester General, Leicester Royal, Arrowe Park Hospital, and Hereford Hospital.


Cite this as: BMJ 2012;345:e4784


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