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7.10 pm

The Minister of State, Department of Health (Caroline Flint): We have had a good debate. We have heard a variety of speeches from Back Benchers—12, I believe—in three hours or so, reflecting the complexity and diversity of opinions on what we have been able to discuss today, let alone other aspects of the report that there has not been time to mention.

I welcome the report, and thank my hon. Friend the Member for Norwich, North (Dr. Gibson), who chaired the Committee that produced it. He passed the gauntlet—if that is the right word—to the hon. Member for Harrogate and Knaresborough (Mr. Willis). As he said, I am due to appear before the Committee next week, and I am sure that it will explore many of the issues raised today in much more depth.

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We have benefited from a number of authoritative reports produced by a variety of Select Committees of both Houses in recent years, but I think it fair to say that few have been as extensive as the one that we are debating today, or have produced such wide-ranging recommendations. The report followed a year-long inquiry involving written evidence gathering, examination of witnesses and, as we have heard today, fact-finding missions abroad. The result of that process has been very thought-provoking. It has led to analysis and to a set of recommendations which—although we may not all agree with them—prompt questions that need to be put, given the pace of change in both science and technology and social issues over the past decade or so in this area of public policy.

Those who read the report, regardless of whether they agree with its proposals, will be compelled to examine their own reasoning and rationale in regard to a host of fundamental legal, ethical and social questions and dilemmas, many of which go to the heart of no lesser questions than what it means to be human and what are the proper limits of toleration in a modern pluralistic society. It is hardly surprising that the report did not have an easy gestation, or that the Committee could not reach unanimity on underlying principles. I should refer at this point to the special report that records the dissent of five Committee members. That too has been reflected in the speeches we have heard, particularly that of the hon. Member for Congleton (Ann Winterton).

I do not think, however, that a lack of unanimity is necessarily to be regretted. It illustrates the complexity and depth of feeling that surrounds these issues, and opens them up to wider debate. Certainly our consultation, whose findings we published earlier in the year, revealed a wide range of views. It would be unfair to suggest, as some Members may have been inclined to suggest today, that there is only one view in the scientific community, or that it does not take the issues seriously. The feedback that I have received suggests that, far from having a “go fast” attitude, many in that community want the issues to be aired fully. They want a full discussion, because they want to feel that there is confidence in their professionalism and their approach to the important matters that have been raised today.

I do not believe that any of the issues we have discussed are easy or admit of a simple solution, or at any rate a solution that can be reached by a simple or easy route. In January 2004 we announced our intention of reviewing the 1990 Act—a process that would include a public consultation exercise in 2005. The Select Committee’s report provided an excellent starting point. We took up many of the issues raised and suggestions made by the Committee, and signalled our willingness to consider potential changes. I hope that our response also identified points on which we agreed with the Committee, and showed that when we did not agree we took on board some of the points that have been made again today. I am thinking of, for instance, the regulatory and policy-making role of the HFEA and the question of where Government oversight should lie.

It is right for us to take time to think through the issues and develop our response properly. As I have said, we made clear our agreement with some of the
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report’s recommendations, and made plain our intention to gather views on others from a wider audience. In common with the Committee, we concluded that the basic foundations of the 1990 Act, as rooted in the earlier report from the Warnock committee of inquiry, remained sound.

I think we should all be very proud of the legislation. Yes, science has moved on, but I think we should be proud of the basic foundation that has served the country so well, not just nationally but internationally. My hon. Friend the Member for Brighton, Kemptown (Dr. Turner) made a good point: that in not being prepared to explore some of the issues that we have explored, those in other countries have allowed the creation of an atmosphere in which it has been possible to develop some of the worst examples of what we do not wish to see. That has often brought into question practices in our own country, but our debates on the issue, and our underpinning legislation, have stood us in good stead and protected us from some of the wider and scarier practices overseas.

The foundations of the report include the idea of a special status applicable to the human embryo, the need for active monitoring and regulation, and a clearly defined time limit on the development of embryos in vitro for research. When we announced our review of the Act, we made clear that several aspects of the current law and scheme of regulation would not be reopened for debate. We felt that those aspects had been conclusively, and in some cases very recently, resolved by Parliament, or the Government had already made clear their established policy intentions. They include the removal of donor anonymity. The hon. Members for South Cambridgeshire (Mr. Lansley) and for Windsor (Adam Afriyie) have expressed concerns about its removal, but children’s organisations and others have said that they consider it right. We have talked a great deal about family and identity today. The view has been expressed that children conceived by means of donors have a right to receive information about those who allowed them to be created in the first place.

As I have said, on the whole the 1990 Act has stood the test of time, and is a tribute to the foresight of its creators. It resulted from an extensive process of deliberation and consultation over several years. It established the principle of independent oversight of an area of medical practice, and I believe it has proved to be remarkably robust in the face of legal challenges. I also believe that it has promoted public confidence in assisted reproduction treatment, and has played a large part in enabling the United Kingdom to move to the forefront of cutting-edge developments in scientific and medical research.

There has been criticism of the HFEA, but I think that it continues to do a very good job in dealing with the novel and complex issues that inevitably come its way. I agree to an extent with the hon. Member for South Cambridgeshire, who said that it was difficult for organisations to look purely at regulation without examining issues relating to policy development as they see it, in the context of their inspection and regulatory processes. I join the hon. Gentleman in thanking Dame Suzi Leather for her leadership and steering of the HFEA. I also thank all members of the board, who constitute a mix of professional and lay people.

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Law and regulation have not stood still since 1990. The House has passed both primary and secondary legislation, either in response to developments or to seize new opportunities. Nevertheless, the Committee and the Government have agreed that there is a growing need to revisit the law, particularly given the rise of new technologies. The Committee had previously expressed that view as a need to

There can be no doubt that developments are moving fast. They include technological breakthroughs in the screening of embryos for hereditary diseases, and we have seen the number of babies conceived through IVF worldwide pass the 3 million mark. That figure includes 100,000 children born in the UK. We need to establish a framework that is broadly acceptable to society, and fit for purpose in the 21st century.

We should remember this, too. It comes from the Warnock report, and it has the same resonance today as when it was first written:

That is an important quote today, as it was then. The report continued:

I believe that a consultative and deliberative approach is key. As we have said, we are keen to continue to explore how wide-ranging a debate we can have and to continue to provide opportunities for more involvement and more debate.

There were 535 responses to our consultation; more than 100 organisations took part. We saw the wide diversity of views. None the less, the ultimate basis for regulation in this area is the public good, and commonly acceptable limits and boundaries. Therefore, the considered views of society as a whole, identified through exercises such as the consultation, the Select Committee report, this debate and debate in the months ahead, are crucial to making sure that we end up with a law as successful as the original law on which it will be founded.

It is clear that responses generally favour measures such as a ban on non-medical sex selection, and retention of a “welfare of the child” consideration in some form. I will talk a bit more about that later. Respondees were generally less convinced of the need to make changes to the scope of permissible embryo research. It will be for Parliament to weigh those arguments, opinions and evidence in its consideration of any proposals to change the law that the Government may bring forward.

There has been much discussion about the role of the HFEA. Some take the view that Parliament could take more of a role not only on that matter but on that movable feast, the way in which science and society develop. In our response to the Committee, we did not feel that a bioethics committee was necessarily the right way forward. We took that view on the basis that the present distributed model of advisory bodies with more specific briefs remained the best option, as it enables specific bioethical issues to be addressed by dedicated groups with the appropriate expertise and sufficient time to devote to the issue. However, we share the Committee’s view that airing and debating bioethical
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issues in Parliament is important, and we are willing to give further consideration to the appropriate level of parliamentary control over delegated powers under legislation. We accept the benefit of wide consultation. As I have said, I am looking to explore how much further we can develop that debate in the months ahead.

Establishing a regulatory authority for tissue and embryos is not just a costcutting exercise, as some people have suggested, or just a neat joining of two organisations. We believe that, through bringing the HFEA and the Human Tissue Authority together, we can have a single competent authority acting as a regulator under the blood, tissue and cells directives, which will reduce any risk of overlap and duplication. We also think that RATE will be better able to work with other regulators such as the Healthcare Commission to ensure common standards and practices. Having a single source of authoritative guidance on all issues related to the use of human tissues of all kinds will be helpful in one organisation. Again, that will help to ensure good practice and guidance established on common principles in those related areas.

My hon. Friend the Member for Bolton, South-East (Dr. Iddon), the hon. Member for Harrogate and Knaresborough and other colleagues talked about the sex selection of offspring. That issue is a good example of why we have chosen to review existing law and regulation. It is established policy that the selection of embryos on the grounds of sex, other than for serious medical reasons, should not be allowed. That position is maintained by the HFEA, which has undertaken extensive public consultation and surveys. That was complemented by the response to our own consultation. However, there is not an explicit statutory ban in law, and nor does the HFEA's policy apply to treatments that fall outside its remit. The rise of new technologies, such as sperm sorting, could therefore allow sex selection to take place in settings outside the scope of regulation.

We consulted on options, including a ban, or a partial ban in line with the Committee's recommendation to allow sex selection for non-medical reasons in order to “balance” a family. It is clear from responses to our consultation that people favoured an explicit ban with no exception for family-balancing, and a range of other surveys have shown widespread public antipathy to sex selection for social reasons.

We must give serious consideration to how a statutory ban could work in practice. As I have said, services on the internet are one factor. My hon. Friend the Member for Bolton, South-East asked whether the Government would regulate internet sperm providers. We have said in our consultation document that we intend to make the operation of internet services involving supply subject to regulation. We have sought views on the detail of that, but clearly, we can apply it only in the UK. We cannot necessarily apply it to overseas practices.

The welfare of the child and the need for a father are another social concern. Concerns about the general welfare of children underpin many aspects of the current legislation. For example, concern about the psychological well-being of the child is a key reason for the ban on human reproductive cloning. However, the
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extent to which the law should intervene in decisions to provide treatment in individual cases, or impose “social” criteria for assisted reproduction clinics is less clear-cut. Whatever view we take individually on the merits of different family forms, the issue is about whether it is the state's role to impose a view. I listened carefully to the comments of the hon. Member for South Cambridgeshire

In 1990, Parliament chose to require clinics to take account of the welfare of the child, including the need of the child for a father; any change to that position will again be a matter for Parliament. The Committee's report is very clear. What emerged from the consultation, interestingly—and, on this occasion, it contradicts the comments of my hon. Friend the Member for Bolton, South-East—is that the medical profession, as represented by the royal colleges and the BMA, feels that there needs to be something that recognises the welfare of the child. The BMA wants a general welfare of the child provision to be retained, and the Royal College of Obstetricians and Gynaecologists wants to subsume those considerations within good medical practice. Therefore, there is a view that the welfare of the child is still an important consideration to be taken into account.

The question of the “need for a father” has again been aired. It is not a straightforward matter. The requirement to take account of the need for a father is not a prohibition as it currently stands. The HFEA is required to give clinics guidance on taking account of the welfare of the child. On that point it says:

We are looking at the response to our consultation on the issue. I am sure that there will be further discussion. Again, we felt it important to put those questions in our consultation because we wanted to reflect the fact that perhaps over time opinions had changed, and the emphasis on the welfare of the child should be paramount in relation to decisions on the issue.

PGD has concentrated colleagues’ minds. The hon. Member for Salisbury (Robert Key) and my hon. Friend the Member for Brighton, Kemptown both spoke about the issue. The screening and selection of embryos, and the grounds on which that may be undertaken, feature heavily in the Committee's report and have done so in preceding reports. Indeed, I believe that that issue, more than any other, led to the instigation of the Committee's inquiry. Although the courts have upheld the HFEA's power to make licensing decisions in that area, the topic remains controversial.

The analysis in the Committee's report is instructive. It raises several facets of the debate, including making sure that embryos are not created and destroyed frivolously, balanced against the avoidance of serious inherited disorders or the ability to treat a seriously ill sibling. It goes on to consider the appropriate setting for decision making and the respective roles of Parliament and the regulator. Responses to the consultation, where they agree that pre-implantation
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genetic diagnosis should be allowed, show that there is a view that there need to be some more explicit criteria in legislation to determine legitimate purposes for which embryo screening and selection may take place. Again, we need to think about how we deal with the pace of change in the science and the role of the authority in the future, as well as Parliament’s input into the decisions.

My hon. Friends the Members for Morecambe and Lunesdale (Geraldine Smith) and for Islington, South and Finsbury (Emily Thornberry) and the hon. Members for Congleton, for Harrogate and Knaresborough, for Oxford, West and Abingdon (Dr. Harris) and for Salisbury (Robert Key) debated time limits. The subject was also touched on by other hon. Members in various ways.

One of the differences between the last time Parliament discussed time limits and now is that then relevant professional bodies exerted considerable pressure in favour of a change. Some hon. Members may have participated in that debate, and I was certainly aware of it. It was clear that the professional bodies felt that the time limits needed to be changed. However, today, the Government have not been approached by any of the relevant professional bodies to state that they have changed their views since the limit was reduced from 28 to 24 weeks in 1990.

At low gestation age, even if the foetus is born alive, there are high risks of death due to immaturity. Indeed, while the possibility of survival of extremely pre-term babies has improved, data suggest that, even with modern intensive care, chances of survival at 22 weeks’ gestation are only approximately 1 per cent., whereas that increases to 26 per cent. at 24 weeks. However, it should be noted that 88 per cent. of abortions are carried out at less than 13 weeks’ gestation, 60 per cent. of which are at less than 10 weeks. Less than 1 per cent. are performed at 22 weeks and over. Only 124 have taken place at 24 weeks and over.

Parliament agreed in 1990 that the legal limit for most abortions should be reduced from 28 weeks to 24 weeks. The debate that informed the decision considered a wide range of issues, including both ethical and practical issues. It is still a matter for Parliament to decide, but I wanted to be clear about the pressures that were coming at the time from professional organisations. That is not happening today. Any proposed changes would need to be carefully thought through, and we have not had the pressure from the organisations for change. The BMA and the royal colleges, which advised the need for a change in 1990, have not given any such advice today.

Mr. Willis: If the Minister is confident—I have no reason to argue with what she has said—that the science has not changed, why will she not agree to an ad hoc Joint Committee of both Houses to put the matter to rest?

Caroline Flint: That is an issue for the House to decide. I was trying to point out the differences between the debate in 1990 and today. In 1990, the professional medical organisations urged the Government to make changes, based on the scientific evidence, but they are not doing so today.

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