Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 400 - 419)

WEDNESDAY 21 JULY 2004

PROFESSOR BRIAN TOFT

  Q400  Mr McWalter: You mentioned the inappropriateness of the response of Ruth Deech and Suzanne McCarthy and the Chairman asked you whether you wanted to be more explicit about that. In a sense, you declined in the end, but it does seem as if their response was incredibly rude actually. Do you think there are powers that exist to be able to call those who are in charge of the HFEA to account? In other words, is there a system in place where, when they behave inappropriately/rudely or whatever, they can be properly held to account and perhaps dismissed in relatively short order if that is deemed appropriate? Or are those superior management structures not much in evidence?

  Professor Toft: My remit was not to look specifically at their management structure as such and therefore I really could not say, Mr McWalter. It just seemed to me that, given the Nolan rules of conduct in public, they had not actually held up to those principles.

  Q401  Chairman: In terms of regulation, do you there is a tendency here to over-regulate on this authority?

  Professor Toft: It is difficult to say in terms of over-regulation. Certainly I think we need regulation in this area. It is fundamental. It is about life.

  Q402  Chairman: How do the clinics feel about it?

  Professor Toft: The clinics—at least from my limited experience of speaking to two of them—in general seemed to agree that regulation was a good thing. At least, that is my understanding, but whether or not everybody else holds that view is a matter of some contention.

  Q403  Dr Turner: Could I come back to this culture of secrecy. How do you think the organisation involved, having the duty to protect patient confidentiality—which is obviously fairly universal and a given in the medical world—developed a culture of secrecy which inevitably brings into question the whole transparency of the organisation once that develops? How do you think it got there?

  Professor Toft: I think it is incrementalism. Incrementalism is a massively underestimated effect: you move slightly and slightly and you do not even realise you are moving into those areas until you have. It took them, if you will, 10 years to get there. I think that over time people became very careful and very worried, and as that moved on they became more and more worried about inadvertently releasing information that should not be released, and so they end up in a situation where they do not even realise they are.

  Q404  Dr Turner: They were unaware they had done this.

  Professor Toft: Absolutely.

  Q405  Dr Turner: What was their reaction when you pointed out to them that they were being unnecessarily secretive, and that there was plenty of information that, with care, they could release?

  Professor Toft: I did not actually say to them directly, "You are being secretive." It was as I looked at the evidence and looked at the evidence I had that I gradually came to the view that they had become very secretive. I did not say to them "Excuse me, but you are being very secretive here." It was the overwhelming amount of evidence that eventually came through that said to me, "This is an organisation where people are actually being very secretive" and then I got an e-mail (which is in my report) where they said they could not even tell each other without senior management permission that an adverse event had occurred. The quinquennial reviews had also mentioned the notion of secrecy and a report by an independent outside consultant had also mentioned that they were being very careful about what they said and also said they were being secretive. So it was not just the information I got but it was the concatenation of information that led me to that view.

  Q406  Dr Turner: Over how long a period had that view been expressed?

  Professor Toft: Years.

  Q407  Dr Turner: So this is a long-standing thing.

  Professor Toft: A long time. A period of—I don't know—probably seven or eight years. Certainly at the very beginning they were concerned to be confidential, but then over time they became more and more confidential until eventually . . . And at what point you draw the line in the sand and say: "This is confidential, this is secret," I am not quite sure.

  Q408  Dr Turner: You are satisfied that this was a cultural process. There were not any financial issues involved.

  Professor Toft: I am quite sure culture was the main thing, and it was driven that way. But there is also the fact that, in terms of finance, it became very clear from the previous committee . . . . I think Suzy Leather said that she was amazed at the amount of budget they have to engage in this. It may have been a whole range of issues that created the culture and I could not say which one was more predominant than another.

  Q409  Dr Turner: Do you think they were worried that people would say they were not justified with a large budget?

  Professor Toft: I really could not say about that at all, but when I did my investigation, when I did my inquiry, that was a product of a whole range of variables that produced that culture. Culture does not spring into existence overnight; it takes time.

  Q410  Dr Turner: Have you noted any changes since?

  Professor Toft: I have certainly seen that they have implemented my recommendations, and they have now made the information available to the public, and I would have said that was a major change from how it was previously.

  Q411  Mr Key: Professor, during the course of this report it is certainly appearing to me that the inspection system is a shambles. Do you think it is?

  Professor Toft: I would not characterise the inspection system as a shambles. I would say that there were vulnerabilities within that inspection system and it is hard to see that which is not there.

  Q412  Mr Key: How could it be improved?

  Professor Toft: I have made quite a few recommendations in my report as to how it could be improved and I stand by those recommendations.

  Q413  Mr Key: Do you think the inspectors should be full time and salaried?

  Professor Toft: That would be my preference. That is of course a matter for the Government.

  Q414  Chairman: Do you talk to Sir Liam Donaldson who commissioned you about your experience?

  Professor Toft: Not as such, no. I submitted my report and that was pretty much it.

  Q415  Chairman: You have not told him what you have told us.

  Professor Toft: I only told him the report. I mean, I have not sat down and gone through it in detail with Sir Liam, no.

  Q416  Dr Iddon: Do you think the Leeds clinic were unlucky in being found out? Do you think other clinics may operate similarly and not be correctly following the procedures laid down?

  Professor Toft: I just could not say, because I do not know. I was invited to look at Leeds and I did so. On what happens in another clinic, I really could not comment. It would not be fair.

  Q417  Dr Iddon: The HFEA relies principally on external inspectors, I believe.

  Professor Toft: That is correct.

  Q418  Dr Iddon: Do you think it would be better if they fully trained up full-time inspectors of their own who were consistent as they went around? They have had some criticism. It is pretty obvious that different inspectors will operate in different ways, but the evidence we are picking up is that they operate in quite different ways.

  Professor Toft: Certainly in different ways. I would agree with that. I would suggest that a full-time inspectorate, given the seriousness of the events they are inspecting or the potential for serious consequences, would be an appropriate way to engage in this.

  Q419  Dr Iddon: Do you think there are conflicts between the licensing and inspector functions of the HFEA?

  Professor Toft: Not conflicts as such. The inspection regime should inform the authority about that which is taking place, so the authority can be informed about it and on whether or not their thinking is currently up to date. That is informative. The authority of course makes sure that things are done in the way they should be. I do not really see a conflict there. I think one should feed the other. One is looking at principles and the other is looking at practice. In my opinion, the principles should be seen to be in practice by the inspectorate. Therefore it is very important to me that they keep the two things together, closely tied together.


 
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