‘Very, very difficult’: Doctors raise doubts over abortion services timeline

Doctors have expressed concerns that they will not be able to implement the Government’s plan to roll out GP-led abortion services from its intended start date in January.

Representatives from the Irish College of General Practitioners and the Institute of Obstetricians and Gynaecologists raised doubts at the Oireachtas health committee about being able to implement guidelines and provide abortion services by the Government’s proposed start-date early next year.

Taoiseach Leo Varadkar has said that legislation to implement abortion services would be introduced during the first week in October so that services would be in place in the new year.

The Eighth Amendment, the constitutional ban on abortion, was repealed on Tuesday after President Michael D Higgins signed the Thirty-Sixth Amendment of the Constitution Bill in 2018 into law after a large majority of voters passed a referendum to remove the prohibition.

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Addressing the Oireachtas committee on the development of guidelines for abortion services, Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists, described the timeline as “challenging”.

He called on all interested parties - including the Department of Health, the HSE and representatives of the medical profession - to “sit down” and decide on a “pathway” for the implementation of services.

“That needs to happen soon so we can get a clear picture of what the requirements are,” he said.

Dr Cliona Murphy, incoming chairwoman of the institute, said doctors “may well be struggling” to finalise the clinical guidelines around abortion services but that implementation was “a far larger process”.

The institute has had two meetings with the Department of Health but was supposed to have had three, and those two meetings were limited to clinical guidelines, not on implementation, she said.

Dr Boylan questioned the inclusion of a three-day waiting period for a woman seeking a termination within the first 12 weeks of pregnancy, describing it as “demeaning to women”.

“There isn’t any evidence that it is necessary,” he said.

He argued it “makes presumptions about women’s ability to make decisions about their own healthcare” and, referring to last week’s CervicalCheck report that criticised how doctors spoke to affected women, adding: “We have heard a lot about paternalism recently with the CervicalCheck problems.”

“It is up to you guys,” Dr Boylan told the committee, saying it was in the hands of legislators. “You know our views on it. It is demeaning to women. The legislature is the one who can fix this, not us.”

Dr Mary Favier, vice-president of the Irish College of General Practitioners, said there was “no medical reason” for the 72-hour waiting period and that it was a “legal, societal decision” and “discouraged” by the World Health Organization.

Dr John O’Brien, president of the college, said he was concerned about the ability of the country’s GP system to provide abortion services from January.

“I would be concerned. There may be other matters taking place within the HSE or the Department of Health which I am not aware of, which might allay some of those concerns,” he said.

He outlined the existing strain on GP resources and services, noting Ireland spends 4 per cent of national health spending on general practice, half the level of the United Kingdom, and that one in five GPs trained in Ireland “go away and stay away”.

He pointed out that 60 per cent of GP practices are closed to new patients, having reached capacity. The general pressure on GP services would have an impact on the delivery of abortion services, he said.

“And there isn’t a plan B?” asked Independent Senator John Dolan. “I don’t even know a plan A,” said Dr O’Brien.

Dr Murphy estimated that, based on figures on abortions in Scotland, there could be 10,000 Irish abortions next year and that 20 per cent of those might require surgical treatment.

Dr Boylan stressed the importance of MRI scans in determining whether fetal abnormalities are fatal or not and said MRI was currently only available in one maternity hospital in the country.

He said that with “some jigging around” the MRI scanner in the National Maternity Hospital could be used as a centre for national referrals but warned of the need to get the system right from the outset.

“The consequences of getting it wrong are very serious; you could end up that a termination will occur for a condition that is not fatal, or vice versa,” he said.

In a thinly veiled reference to the recent criticism of the governance and reporting structures within the CervicalCheck cancer programme and its clinical audit in last week’s Scally report, Dr Boylan warned: “We want to be sure that the system is not set up to fail as we have seen already with other systems.”

Dr Murphy said the timeline to introduce abortion services was “tight.”

“We are not saying that it’s not possible, but just that it’s going to be very, very difficult; that needs to be acknowledged, and a lot of work has to be done between now and then to get the service up and running,” she said.

Asked by Labour TD Alan Kelly about the coverage of abortion services in remote rural areas, Dr Favier said this was a concern of GPs and that the college had not been in position to do a “mapping exercise”.

She suggested innovative plans such as providing a mobile service where a provider is sent into a remote, rural area so women “won’t run the gauntlet in a small town of trying to find somebody”.

Fine Gael TD Kate O’Connell expressed concern about a mobile unit and had “a vision of the big van” coming to a small town, saying it was “not in any way suitable to provide women’s healthcare”.