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12 Dec 2007 : Column 432


7.54 pm

Jessica Morden (Newport, East) (Lab): I present this petition of more than 1,000 signatures on behalf of Deborah Harvey. She is one of my constituents and a former Farepak agent who has campaigned long and hard for justice for those affected by the company’s collapse. The petition

Following is the full text of the petition :

[ The Petition of those affected by the collapse of Farepak,

Declares that the collapse of Farepak in October 2006 caused 122,000 people to lose their Christmas savings; that many families suffered financially and emotionally from that loss; and that they deserve reimbursement. Furthermore, it has been over a year since the collapse of Farepak and it is unlikely, according to the administrators, that any money will be paid back to its customers by Christmas this year.

The Petitioners therefore request that the House of Commons urges the Prime Minister to speed up the process of paying money back to the affected customers before Christmas this year; and further urges that if any culpability is found against any of the directors of Farepak that action will be taken and will he ensure that previous honours bestowed to them, if any, will be removed.

And the Petitioners remain, etc. ]


M25 Noise Pollution

7.55 pm

Mr. David Gauke (South-West Hertfordshire) (Con): This petition relates to the widening of the M25 and the concern of a number of my constituents living close to it that inadequate steps are being taken to reduce noise pollution. As a resident of Chorleywood, which is near the M25, I declare that I am affected by this.

The Petition of residents of Chorleywood and others from the constituency of South-West Hertfordshire and others,

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Assisted Reproduction Services

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Alan Campbell.]

7.56 pm

Dr. Ian Gibson (Norwich, North) (Lab): I wish to put into context a few remarks about assisted reproduction. It is indeed a large-scale subject, which could take hours and days to go through, but several issues are important, particularly in respect of some of the legislation being introduced after the Christmas break. We have to consider some of those issues.

Let me put the subject in context first. Figures published yesterday by the Office for National Statistics show that the population of the UK is growing at the highest rate since the 1960s and that total fertility rates have risen since 2001 from a record low of 1.63 children per woman to 1.84 children per woman in 2006. Indeed, it is interesting to note that they are now at the highest levels since the 1980s. In the 1980s and 1990s, the fertility rates of women in their 20s were actually declining. Since the 1970s, as more women have entered higher education and the labour force they have been increasingly delaying reproduction into their 30s or 40s and this has led, I think, to a greater need for assisted reproduction. That seems to correlate with the demand for assisted reproduction.

The rise in fertility over the past five years, as reported by the statistics unit of the ONS, is a result—it says—of a large increase in immigration from abroad, as well as the increased support for child care and the maternity legislation introduced, of course, by the Labour Government. The ONS points out that some 20-odd per cent. of births were to people who were born abroad. There is some argument about that and its relevance, but it implies that immigration can develop fertility rates in this country to a higher level. That has yet to be shown over a period of time.

The general trend in Britain towards a declining birth rate is mirrored in western Europe. Several factors, such as lifestyle factors, an increase in sexually transmitted diseases and a rise in obesity, as well as environmental factors involved in urbanisation and urban lifestyle that affect fertility, have led to a rise in male and female sub-fertility. There are also socio-economic factors, which have allowed couples, as I say, to delay having children. Lack of affordable housing, flexible and part-time career posts for women, and affordable and publicly funded child care have contributed to those low fertility and birth rates.

Couples are delaying starting a family, which has led to a decline in fertility levels due to ovarian ageing and related reasons that have led to a reduced chance of conception. Other factors include tax increases, changes in national insurance and so on, but the main thing I am trying to point out is that the reproductive rates and the need for assisted reproduction are reflected in wider events in our society.

However, I do not want to talk only about reproduction and social issues; I want to spend some time on the issues of scientific service and assisted reproduction treatments. I have a feeling that unless we are careful, the debate on the Human Fertilisation and Embryology Bill will get taken over by a lot of bioethical issues, as we saw in the recent debate in the
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Lords, and we will end up talking about regulation, rather than considering the new scientific endeavours that are coming forward. Of course we must debate bioethics—no one is against that—but I want to talk about assisted reproduction and some of the things that are happening.

We talk about in vitro fertilisation, but in practice assisted reproduction is more than that. It includes all fertility treatments—ovulation induction, interuterine insemination and gamete intrafallopian transfer, as well as IVF. There are various ways to add eggs and sperm together to allow the conception of a child, yet we regulate only IVF. We do not consider whether the other ways of developing an embryo should be regulated. That is quite obvious in the Bill, which is lacking in that those other technologies are not considered. I guess we think that IVF will be the only treatment in the future. Because of that, we worry about the welfare of the children and about the need for a father—all these issues are being debated—but what about the welfare of the woman and the effects of treatments on her? For example, ovarian stimulation, whereby women are, in my opinion, overdosed with vast amounts of hormones, is being shown to be quite unnecessary. A single dose of a hormone or a reduced level can be just as effective in producing eggs and, at the end of the day, the embryo.

In the regulation of assisted reproductive technologies, medical practices, laboratory practices and new technologies and research are all regulated by the Human Fertilisation and Embryology Authority, which has concentrated on those areas. There are inconsistencies in clinical protocols, the uses of drugs, dosages and practices. People, particularly women, are confused about the gross inconsistencies in clinical practices and they feel vulnerable. I think that the entire service should be delivered within the NHS, but I am not going to say that people are being forced into the private sector, to pay astronomical sums of money to receive any of those treatments, many of which have certainly not been scientifically studied or undergone proper clinical assessment.

In my opinion, the Healthcare Commission has been efficient in regulating and monitoring clinical practices, looking at clinical complications, including morbidity and mortality, and taking effective action where necessary. Perhaps the Healthcare Commission should regulate IVF medical practice, with advice from the National Institute for Health and Clinical Excellence, the Medicines and Healthcare products Regulatory Agency and the royal colleges. We need an efficient and accessible clinical watchdog, but that is not proposed in the Bill at all. We are talking about legislation to deal with assisted inception involving IVF treatment, which is the mainstream clinical treatment, but we need a watchdog—a Government or parliamentary body—to address how it should be assessed and funded. Joining two bodies together seems to have been rejected, with a single body being put forward. We need to debate that. All those issues will have to be discussed in the debate on the Human Fertilisation and Embryology Bill, but I have my worries that that will not happen.

My further worry is that people will tag on amendments to the Bill about abortion. I am quite prepared to stand and argue about the principles of abortion for days and days, as are other people; but if
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we are not careful, abortion will be tagged on to the debate through amendments and take it over, meaning that the issues that I am raising will not be reflected in the good legislation that all sides recognise we need, in terms of the outcomes of research and so on.

We also want a clear and comprehensive presentation of information to the wider public. Term live birth rates should be a measure of success rates. League tables are published in A Patient’s Guide, but I think that it contains misleading information, and that detailed information about clinical trials should be included. Information about complications, morbidity and mortality rates per clinic should be published, not just success rates. The public need to know all that as well. It would be good if reports followed up what happened to the women involved and their children at different stages in their lives, but we do not have much information about that either.

I think that if we are not careful, we will not get through all the issues that will be discussed when the Bill is debated. We will spend a great deal of time discussing all the ethical and moral issues surrounding the decision of same-sex couples to have babies, and we will also be expected to try to discuss abortion, which will be quite impossible. I think—and I hope the Minister will comment on this—that either a Joint Committee or a House of Lords Committee should consider abortion in its own right, taking account of all the evidence that is presented. I do not mean just scientific and medical evidence, but evidence dealing with the moral and ethical aspects. A House of Commons Committee was established, but examined only the scientific aspect. The issue should be seen as a whole in the context of the society in which regulations will be implemented.

Will patients be charged for eggs? Will fees be charged for individual cycles? Will three cycles be necessary, or will one be sufficient if less hormone is needed for stimulation purposes? I initiated a debate on the issue in Westminster Hall a few months ago, when my right hon. Friend the Member for Doncaster, Central (Ms Winterton) was the Minister responsible for public health. I think she considered the points that I made, and I should be pleased to hear whether there have been any developments in relation to reduction in the use of hormones which, in my opinion, seriously affect embryos and women’s health. I believe that smaller doses could produce equally high success rates.

That leads to the question of the number of embryos that are being implanted. We want only one to be implanted; we do not want multiple births and all the concomitant problems that may arise. According to Scandinavian countries, current technologies can be quite successful in developing a single embryo that proves healthy and able to bring satisfaction to people’s lives. People want to have children, or to continue to have them, but for various reasons—which I have outlined—cannot have them. It is possible that infertility is more rife than it used to be.

I want to say a little about survivors of cancer, particularly young people who receive severe treatment and whose ovaries may be damaged if it continues for a long time. It is their choice, or that of their parents or loved ones, but I think there should be a way of determining whether the sperm and egg should be stored for use in later life, after they have recovered. We
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had a ceremony today involving CLIC Sargent, which is involved in such cases. Thankfully many young people have recovered—survivorship is the name of the game for young people with cancer now—but many have been severely affected at one stage in their chemotherapy treatment, and the treatment may have damaged their eggs or sperm. We need a mechanism to ensure that if they want assisted-reproduction techniques to be applied to their sperm and eggs, those techniques are available. I do not think that such issues are entirely reflected in the Bill.

Many people have drawn attention to the continuing problem of postcode prescribing. The way in which primary care trusts operate the technologies varies greatly—they are available in some areas but not in others—and I think we need a proper analysis of the position. We hear about drugs, but we should know more about the technologies. I am excited about all the new possibilities, and the way more people are being give the right to have children. However, when we are drawing up a human embryology Bill, we should ensure that it reflects all the developments that are taking place out there. We should not nit-pick when it comes to technologies. We should not regulate some and fail to regulate others. Hopefully we will not regulate some of them; self-regulation may be possible. However, I doubt that very much, when we still have strong private sectors in the health service and we are coming from a situation where assisted reproduction is still costing those who are rich and can afford it lots of money and other people cannot afford it and cannot have the treatments. That is a real challenge for the Government and these issues will come to the fore during the debate on human embryology. We must talk about it fully, and not just nit-pick. I speak as somebody who chaired the Select Committee that dealt with this issue, and who has the scars on my back to prove it. I also served on the Joint Committee. Everyone thought it was an interesting area to discuss, but they felt disquieted afterwards that many issues had not been touched on. I hope the Minister will pick up on that and be able to say whether we will be able to do a good job or an excellent job.

8.10 pm

The Minister of State, Department of Health (Dawn Primarolo): I congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on securing the debate, which is on a subject of great concern to many people in all our constituencies. May I begin by making a few remarks on his comments on the Human Fertilisation and Embryology Bill, which is currently being discussed in another place? It provides not only for in-vitro fertilisation to be regulated, but for donor insemination and artificial insemination to be regulated, and it has recently been extended to cover the regulation of donor sperm services provided through the internet. The remit of the regulations for fertility treatment was considered by scrutiny of the draft Bill in a Joint Committee of both Houses. In responding to the report, the Government took note of the strong arguments that had been put.

Although the Bill is not the subject of the debate, may I remind my hon. Friend that its main provisions are to ensure proper regulation of all human embryos that are outside the body, whatever the process used in
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creation? It is also about the regulation of embryos created from combined human and animal genetic material for research. It will make sure that there will continue to be a ban on sex selection of offspring. It recognises family and social support and the best interests of the child. It also makes alterations by lifting some of the restrictions on collected data to make it easier to do follow-up research. May I also remind my hon. Friend that abortion is not included within the scope of the Bill and that that will be a matter for this House?

My hon. Friend also touched on the important question of the services available now through the national health service for those seeking fertility treatments. Since becoming the Minister for public health, I have, as we would expect, received letters from people who cannot have a child and find that their local primary care trust cannot help them immediately. In some cases, their PCTs have said that they cannot help them at all. Those letters express the distress people feel in that situation—the impact of finding out that their family will not happen as planned, and in many cases the sense of being let down by the national health service.

My hon. Friend referred to a postcode lottery in prescribing. There are of course many other people who do receive NHS fertility services, and I hear far less from those people, as we would also expect. Even so, those receiving IVF treatment are unlikely at present to be receiving up to the three cycles of IVF as set out in the National Institute for Health and Clinical Excellence guidelines. I have made it clear in this House that I am concerned about this inequitable access to IVF, and I have no hesitation in saying today that we need to address that. In a moment, I shall update the House, and my hon. Friend in particular, about the further steps being taken.

My hon. Friend spoke with a great deal of feeling about the ways in which we could look at assisted reproduction treatments differently, encouraging lower doses of drugs and ensuring that all the treatments are regulated in the best possible way. The Bill’s proposal is precisely to undertake that. I would be pleased if he were to write to me in detail, if he feels able, about the particular points and concerns that he is raising.

More generally, clinicians and others may have evidence about particular treatments, including new ones. The Department of Health has asked clinicians who favour minimal assisted IVF to give evidence directly to the National Institute for Health and Clinical Excellence. In progressing this approach, it must be made clear that where clinicians and others have evidence about treatments, which may be new or not commonly practised, it would be helpful if such information was made available to NICE. In 2008, NICE will be assessing whether its fertility guideline needs to be updated and, if so, to what extent. It is right that it should have the information in order to take that decision. I implore my hon. Friend to follow that approach.

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