Examination of Witnesses (Questions 440
- 459)
WEDNESDAY 21 JULY 2004
MS ANGELA
MCNAB,
MS TRISH
DAVIES, MR
CHARLES LISTER
AND DR
CHRIS O'TOOLE
Q440 Chairman: In relation to Warnock,
which is 20 years old now, where should we start afresh, do you
think? Or is it good enough?
Ms McNab: As we have outlined
to you, in terms of the act I think there are some key areas where
there is the potential for us to think again. One of them is the
scope of regulation that we have in the current act. There are
some treatment services that currently fall outside of legislation
and our own regulation, and I think that is an area of risk. So
fresh sperm and eggs, for example, the internet services which
I am sure the Committee will have read about, fall outside. I
think that is an area that would be very important to—
Q441 Chairman: You have provided
us with a list. How long has that list been in existence? We did
a report in 2002. Was that list there before then?
Ms McNab: I am not conscious that
the authority particularly sat down and considered where there
was potential for review of the act at that time, but I can say
that over the last 18 months this has been an area where we have
been thinking very hard and we have concentrated our minds on
what we think the priority areas would be for review.
Q442 Chairman: We asked for that
in the report, if you remember. We said these things should happen.
You have not communicated with anybody, you have not moved on
as a result of our report.
Ms McNab: We have addressed the
areas that were listed in the report. I think I am misunderstanding
your question. Are you saying that we should have given a list
to government earlier regarding the areas where there was potential
for change?
Q443 Chairman: Yes, that is right.
When did you give the Department of Health your list?
Ms McNab: Verbally, we have been
discussing this for some time—certainly since I have been
with the authority, which is nearly two years.
Q444 Chairman: Two years.
Ms McNab: I have been with the
authority nearly two years and certainly over that time—
Q445 Chairman: Did you have the list
drawn up when you came to the authority?
Ms McNab: I did not physically
draw up a list of where I felt the act could be amended, but it
is certainly the areas where there were vulnerabilities we have
been discussing for some time.
Q446 Chairman: Do you think you need
to regulate as much as you do? In terms of starting afresh, do
you think you over-regulate?
Ms McNab: I do not believe that
we over-regulate, although I do think we need to be flexible in
the way that we regulate. I think that something we should continue
to discuss, both with the professionals and also with the patients,
is what form of regulation would be the most well-balanced and
the most certain. I would like to bring Trish in for a minute
to talk about regulation and how it works now and what she thinks
the balance could be, but could I make one opening remark before
she comes in. I think there has to be a balance in regulation
between absolutely ensuring patients' safety—and we have
heard from Professor Toft's report that the public and patients
want to be assured that there is a real rigorous scrutiny of what
goes on in clinics, that there is not the potential for things
to go wrong—with not being so bureaucratic or so burdensome
on clinics that, frankly, we hold up their work or we are very
resource heavy. I believe we are constantly looking at that issue.
We have made changes which Trish will tell you about; we have
more to look at. But that is a balance that we are very acutely
conscious of.
Chairman: We will ask Trish later on.
We are going to take about over- and under-regulation and what
areas you might devolve to somebody else.
Q447 Dr Harris: Why was there a delay
of several months between the submission of Professor Toft's report
and its publication?
Ms McNab: That was a matter for
the Department of Health. I cannot tell you what the reasons for
that would be.
Q448 Dr Harris: Did you not ask why
a major report about your functions, which was going to be very
helpful to you, was sitting on a shelf or a desk somewhere in
the Department of Health? You must have been interested to know
the publication date and why it was delayed.
Ms McNab: Absolutely. I was very
much involved with Professor Toft, certainly in the latter stages
of the report, and the review that he was carrying out—he
has already talked to you about the cooperation we gave him. In
conversation with him, therefore, I was aware of the key areas
where there were recommendations that he was making, so I can
guarantee to you or reassure you that a delay in the publication
was not delaying anything that we should be doing. From that point
of view, the frustration was not a great one for me because I
was already working on the improvements that needed to be made.
Q449 Dr Harris: So it did not concern
you that it was not being published and might not be published.
You had the inside information, and, as long as you knew—
Ms McNab: No, no. I am very sorry
if I have misled you. I was totally reassured that it was going
to be published. I was aware that there was a process to be gone
through to get it to publication. I did not have doubts that it
would be published in full.
Q450 Dr Harris: Why was there this
delay?
Ms McNab: I cannot answer that.
Q451 Dr Harris: Did you ask the Department
of Health why there was the delay?
Ms McNab: My understating was
that there were amendments being made, tidying up being done,
printing arrangements being made, that an appropriate date was
being found. That is not my business; my business is to make sure
that the recommendations are put in place and that the changes
that need to be made are made, and also to make sure that when
the review was going on that the information that is required
by that review was given promptly. I am satisfied that I did that.
Q452 Dr Harris: The reasons you understood
for the delay were amendments—presumably typographical amendments—and
finding a suitable publication date.
Ms McNab: As far as I am aware,
administrative communication issues. As I say, that is not my
main sphere of business; my sphere of business is to make sure
the improvements have been made.
Q453 Dr Harris: What opportunities
were there for witnesses to Professor Toft's inquiry to view the
report before its publication?
Ms McNab: In line with due process,
any of the members of our organisation who had contributed as
witnesses were asked to look at an early draft and to comment
on any inaccuracies that there might be. They were not asked to
comment otherwise, but, clearly, as with other reports of this
nature, they were asked to correct any inaccuracies.
Q454 Dr Harris: This was well before
publication.
Ms McNab: Yes, after a first draft.
Q455 Dr Harris: What about other
witnesses who were given an opportunity to review the report before
publication? Are you aware that they were given an opportunity
the day before publication?
Ms McNab: I am sorry, Trish, do
you want to say something?
Ms Davies: No.
Ms McNab: No, I am not aware,
"the day before".
Q456 Dr Harris: We understood that
one witness received an e-mail, in the afternoon at five o'clock,
telling him that if he wished to view the report before publication
he would need to visit your offices between nine and eleven the
next morning.
Ms McNab: I do not recall that,
but I am very happy to look into it and to come back to the Committee
to clarify that point. If I have forgotten something, then I will
be very happy to put the record straight.
Q457 Dr Harris: Was there a media
briefing from the HEFA to witnesses and other interested parties
before the publication of the report, giving information to people
who might be asked following the publication—
Ms McNab: We certainly shared
with members of staff who had acted as witnesses and prior members
of staff the response that we would be issuing. We felt that that
was courteous, that they would know what we were going to say
publicly, and that was no secret.
Q458 Dr Harris: These other reports
that have not been published, which you heard the discussion about
earlier with Professor Toft, is that a concern to you?
Ms McNab: My concern is to make
sure that since I have been working at the Authority we have implemented
a system of absolute openness of reporting of any adverse incidents,
and that we act as a conduit, therefore, for learning, to prevent
any further incidents of that kind occurring. Since I have been
with the Authority, I very early on started discussing this issue.
We have introduced this brand new Alert system. It is the only
one of its kind across the world. My concern is to make sure that
works well, that we get the highest possible reporting that we
can, and that we learn from every event and share those recommendations
very swiftly across the whole of the UK. Again, I would like to
bring Trish in here because she has the responsibility for regulation
and for the management of those kinds of issues and I think what
she could say would be very helpful.
Q459 Dr Harris: I think there are
other questions that other members will have on the Alert system,
so, as the Chairman said, you will get your chance. I am interested
in this issue of publication, of confidentiality. Professor Toft
referred to other reports that have been commissioned less formally
on other adverse incidents that have not been published.
Ms McNab: No, I think there may
have been a misunderstanding. To my knowledge—and I am very
happy to go back and check on this and to correct it if I find
I am wrong—there have been no previous inquiries or investigations
of this kind, of an external nature, such as Professor Toft's,
into previous events.
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