Abortion notifications and data - changing the process: consultation

Background

Requirements of the Abortion (Scotland) Regulations 1991

5. The Abortion Act 1967 requires registered medical practitioners (doctors) who have terminated a pregnancy, to give notice of that termination to the CMO, and, where this is required by Regulations, to provide certain other information relating to the termination. This is done using a form set out in schedule 2 of the Abortion (Scotland) Regulations 1991^[2] (the 1991 Regulations). The doctor must currently return the form to the CMO by post or deliver it in a sealed envelope within seven days of the termination. The 1991 Regulations permit the information provided in the notification forms to be shared by the CMO with PHS, which uses the information contained in the forms to produce annual statistics. These statistics provide valuable information regarding the demographics of patients seeking abortions and other factors, such as the proportion of patients having abortions at different gestations.

6. The current form of notification - contained in schedule 2 of the 1991 Regulations - is set out in the Annex for information.

7. Any changes to enable notifications to be sent electronically, to amend the timescales doctors have to submit notifications within and to update the information provided in a notification would require the 1991 Regulations to be amended.

Current arrangements

8. In Scotland, under the current system forms are filled out by hand and then sent by courier or recorded delivery, or hand delivered, to the CMO within seven days of the abortion taking place. The CMO’s office transports the envelopes to PHS. Staff in PHS then enter the data they require from the forms onto their database in order to allow them to compile the monthly and annual abortion statistics. The hard copies of the forms are kept securely locked away for six years before being securely destroyed.

9. In England and Wales, abortion providers have for a number of years been able to provide their notifications of abortions electronically via a bespoke IT system developed by the Department of Health and Social Care (DHSC), although some providers there still use paper forms.

Proposals for changes to these arrangements

10. The Scottish Government proposes to change the current arrangements to improve the security of the data transfer and the accuracy of the data collected by both moving to an electronic process and avoiding the extra step of information about the abortion being sent via the CMO.

11. Due to the requirements of the Abortion Act 1967, this will still require a doctor to send a notification of each abortion they have carried out or supervised to the CMO, but in future that will be a simple notification of numbers of abortions during a particular time period. No personal data about the patients would be provided in these notifications. It is likely that notifications would in future be requested by email rather than on paper, but arrangements would be confirmed to providers subject to the feedback from this consultation. The Scottish Government would however ask the doctor sending the notification to indicate which NHS Board or private provider they worked for (unless this was clear from their email address or other means).

12. Separately, NHS Boards and private providers would be asked to provide data securely direct to PHS. This is likely to use similar means of electronic data transfer that PHS already use to collect data on other aspects of healthcare from NHS Boards and other healthcare providers, but would be confirmed following PHS discussions with providers. PHS would therefore work with providers to agree the data required and would carry out the relevant Data Protection Impact Assessments, for example to ensure that they are only collecting personal data where that is necessary and that they have robust arrangements in place with providers to ensure the data transfer process is secure.

13. There are a number of reasons why we would like to make these changes. Firstly, the forms currently contain sensitive (special category) personal data about women who have had abortions, as well as the names and contact details of the doctors who signed off each abortion. It is therefore vital that this information is transferred and kept securely. Measures are in place to ensure the security of the data; however sending personal data directly to PHS and using an electronic system should ensure greater data security as it can ensure access to the data is restricted to only those who need to see it. While the notifications to CMO would no longer contain personal data, we propose that enabling them to be sent electronically in future will make the process easier and more efficient for providers.

14. In addition, the Scottish Government would hope that using an electronic means of collecting data would help reduce the time taken for abortion providers to provide the information as they would no longer need to complete yellow forms, and avoid the need for PHS staff to spend time manually entering the information into their database. It should also reduce errors in the forms. While PHS tries where possible to obtain missing information or correct identified errors or unclear entries by email, where forms are not signed they have to be sent back to the provider by post. In England and Wales, the proportion of errors and missing information in forms decreased significantly after the introduction of their IT system.

Proposals for electronic notifications

15. The Scottish Government proposes to amend the Abortion (Scotland) Regulations 1991 (regulation 4) to require notifications to the CMO to be sent electronically. Processes for providers doing that would be set out in guidance from the CMO’s office. We would allow time for PHS to put in place the new arrangements for compiling abortion data before the changes to the Regulations come into force.

Timescales for providing notifications

16. Currently the Regulations require doctors to return a notification within seven days of the termination, although the Scottish Government does not take any formal action against providers if this deadline is missed. However, we know that some doctors find it difficult to meet these timescales due to work pressures. We also know that it may not be clear within seven days if the patient needs any further treatment.

17. In England and Wales, providers have fourteen days from the date of the termination to return notifications (either electronically or by post). A longer deadline would not impact on the statistics under these proposals as this deadline would only cover the simple notifications of numbers of abortions to the CMO (and not the more detailed information which would be shared with PHS by providers). The Scottish Government would therefore be grateful for views on whether the current seven day deadline should be retained or whether providers should be given a longer time period, such as fourteen days, one month or even three months, to return notifications.

Proposals for changes to how information is provided to Public Health Scotland

18. As noted above, the Scottish Government proposes to amend regulation 4 of the 1991 Regulations to (i) allow a simple notification to be sent to the CMO electronically at regular intervals where a registered medical practitioner would notify the CMO regarding how many abortions they had provided or overseen over a certain time period, and (ii) remove the requirement to provide to the CMO other information relating to the abortion in the form set out in schedule 2. Schedule 2 would be revoked to remove the current form of notification (the yellow form).

19. The Scottish Government is exploring the best legal avenue under which PHS can compile data on abortions. Subject to the responses to this consultation, we would hope to be able to implement the new arrangements fairly soon after amendments to the 1991 Regulations are considered in the Scottish Parliament. However, we will discuss this further with PHS and abortion providers to ensure they have sufficient time to fully prepare for the changes, including agreeing what information should be provided about each abortion in future and putting in place secure data transfer arrangements.