Quality standard
Quality statement 3: Waiting time for an abortion
Quality statement 3: Waiting time for an abortion
Quality statement
Women who decide to go ahead with an abortion have the option to have the procedure within 1 week of assessment.
Rationale
Abortion is very safe overall, but as morbidity and mortality increases for every additional week of gestation, earlier abortions are safer than later ones. Reducing waiting times for assessment and treatment can ensure that women have more options for procedures, reduce the risk of complications and improve the woman's experience. Once a woman has decided to go ahead with a medical or surgical abortion at their assessment with the abortion provider, they should have the option to have the procedure within 1 week if they wish.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements to ensure that women who decide to go ahead with an abortion have the option to have the procedure within 1 week of assessment.
Data source: Local data collection, for example service protocol and availability within 1 week of assessment for different abortion methods and gestational ages.
b) Evidence of local referral pathways if a service cannot provide the procedure within 1 week of assessment.
Data source: Local data collection, for example referral strategies and shared care pathways, including pathways for women with complex needs.
Process
a) Proportion of women who decide to go ahead with an abortion who have the option to have the procedure within 1 week of assessment.
Numerator – the number in the denominator who have the option to have the procedure within 1 week of assessment.
Denominator – the number of women who decide to go ahead with an abortion.
Data source: Local data collection, for example waiting time to the next available treatment slot.
b) Proportion of women who decide to go ahead with an abortion who have the procedure within 1 week of assessment.
Numerator – the number in the denominator who have the procedure within 1 week of assessment.
Denominator – the number of women who decide to go ahead with an abortion.
Data source: Local data collection, for example audit of patient records. As some women will choose to wait longer for an abortion, local areas should agree the expected performance in relation to this measure.
Outcome
a) Average waiting time for abortion from initial referral to receipt of procedure.
Data source: Local data collection, for example abortion provider annual reports include data on average waiting times for medical and surgical abortions and different gestational ages.
b) Proportion of abortions performed at under 10 weeks.
Numerator – the number in the denominator performed at under 10 weeks.
Denominator – the number of abortions.
Data source: The Department of Health and Social Care's abortion statistics includes data on abortions performed at under 10 weeks.
What the quality statement means for different audiences
Service providers (such as NHS hospital trusts and independent abortion providers) ensure that they have the capacity to provide abortions as soon as possible and within 1 week of assessment. Service providers work together and share information so that women who are referred to another provider do not need a repeated assessment and can have the procedure within 1 week of the original assessment.
Healthcare professionals (such as doctors, nurses and midwives) ensure that women who have decided to go ahead with an abortion have the option to have the procedure within 1 week of their assessment. Healthcare professionals have a discussion with women who would prefer to wait longer for an abortion about the implications of waiting longer. If the woman needs to be referred to another provider, healthcare professionals arrange the referral and share information about the assessment without delay.
Commissioners (clinical commissioning groups) commission abortion services with the capacity and resources to provide abortions as soon as possible and within 1 week of assessment. Commissioners support collaboration between providers and ensure that shared care pathways and information sharing agreements are in place between providers. This is so that women do not need a repeated assessment if they are referred to another provider and the procedure can be arranged without delay.
Women who decide to go ahead with an abortion can have the abortion within 1 week of their assessment if they wish.
Source guidance
Abortion care. NICE guideline NG140 (2019), recommendation 1.1.6
Equality and diversity considerations
Some women in vulnerable groups may find it difficult to attend an appointment for an abortion at short notice for a variety of reasons. These include caring responsibilities, difficulty in making travel arrangements, financial difficulties, mental health problems, domestic violence and stigma. Service providers should have a flexible and supportive approach that helps women to choose a convenient time to have the abortion.
Healthcare commissioners should consider providing upfront funding for travel and accommodation for women on a low income who are eligible for the NHS Healthcare Travel Costs Scheme or need to travel to a service that is not available locally (including those who self-refer to the abortion provider). Healthcare commissioners and providers should make information available about how to access any upfront funding.