Belfast HSC T rust The Introduction of the first NHS Early Medical Abortion Service in Northern Irelandan emergency response to the Covid19 pandemic Background In October 2019 abortion was decriminalised in NI but no service commissioned ID: 935434
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Slide1
Dr Siobhan Kirk, Dr Leanne Morgan Belfast HSC T rust
The Introduction of the first NHS Early Medical Abortion Service in Northern Ireland-an emergency response to the Covid-19 pandemic
Slide2Background
In October 2019 abortion was decriminalised in NI but no service commissioned
The Abortion (Northern Ireland) Regulations 2020 came into effect 31/03/20
UK lockdown measures 23/03/20 in response to Covid-19 pandemic Travel restrictions –difficult to access abortion care in England(two women attempted suicide when flights were cancelled)End of March/early April at home use of mifepristone approved in England,Scotland,Wales and Ireland-NOT in NI regulations
Slide3NI Abortion and Contraception Taskgroup (NIACT)
Multidisciplinary-input into the commissioning, development and implementation of an abortion service in NI
First meeting 30/03/20- priority to set up temporary emergency early medical abortion service throughout NI ideally within existing SRH services
Within days an EMA service was established in two of five Trusts
Slide431st March 2020
Slide5Legal Requirements in NI-EMA
Estimated gestation up to 9 weeks and 6 days
Mifepristone must be taken on NHS premises
Certification form completed-one signature/kept in clinic 3 yearsNotification form must be completed and sent to CMO within 14 days
Slide6Development of the EMA Service
Willing staff identified and online training resources utilised
Clinic documentation/protocols/policies/patient information produced in line with RCOG/NICE guidelines
Template for telephone consultation/treatment /follow up forms for online Lilie IT system designedPharmacy links established and medication ordered
Slide7Referral Pathway
Informing Choices NI agreed to be Central Access Point
Women self refer to Informing Choices NI
Non-directive pregnancy choices and post pregnancy counsellingInitial assessment and safeguardingDaily referral via secure email to each clinicClinic contacts patient for telephone consultationClinic locations-Belfast, Ballymena, Londonderry, Dundonald and Portadown
Slide8EMA Consultation &Treatment
Initial telephone consultation then appointment to attend clinic
Scan if clinically indicated
First tablet Mifepristone must be taken in clinicSubdermal contraceptive implant insertion/ IM contraceptive injection/contraceptive pill supplied/option to return for coil Take home pack with misoprostol,analgesia,patient information leaflet and low sensitivity pregnancy test
Slide9First 3 months-NIFirst EMA treatment on 9
th
April 2020, within 8 weeks there was a regional service
572 women referred for treatment,524 consultations,447 treated1/3 treatments were very early medical abortion (VEMA)Contraception offered at all clinics, high LARC uptakeExcellent patient feedback and no reported serious complications
Slide10Slide11Belfast clinic in focus :April-July 2020
Trust with the highest number of referrals -48%(252)
Average time from referral to consultation 1.58 days
Average time from consultation to treatment 0.81 daysAverage age 28.9 years40.6% had USS50.9% opted for LARC
Slide12Gestation at EMA*All less than 10 weeks
30.2%
were less than six weeks (VEMA)
*7 found to be greater than 10 weeks on USS and referred to other services within and outside NI
Slide13Contraception following EMALARC uptake: 108 (50.9%)
189 (89.2%)
opted for a reliable method
Slide14Service User Feedback
Great to have in NI. Should be available in NI in
longterm
.
What you are doing in lockdown is perfect. Discreet, essential service. Needs to continue.
Service was great. I did not expect such a wonderful service. Would recommend.
Was worried I was going to be seen going into clinic. Am glad it is a mixed service!
Great, well supported, friendly, non-judgemental.
Really thankful – really impressed with service. Thank you
The staff made it so much easier. I felt very comfortable and safe.
Slide15We have come a long way but…
Abortion remains a highly emotive issue with considerable political resistance
The Department of Health NI have said it is a matter for the NI Executive and they are under no legal obligation to commission services
The temporary service in the Northern Trust has ceased from 2nd October 2020 due to restoration of contraceptive services and continued local access in NI is unlikely Many women still need to travel to England
The Regulations do not allow for at home mifepristone
Slide16The future-where do we go from here?
Urgent need for a comprehensive, funded and commissioned service
The future of the temporary EMA service is uncertain
No surgical option or treatment over 10 weeks gestation
We need the continued support of FSRH,RCOG and BSACP colleagues
Improved access to LARC/immediate postnatal contraception