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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