Dawn
Primarolo: The hon. Gentleman creates a case, advances it,
and then, when he does not get the answer he wants, says that a
justification has not been given. He asked me a question about
discrimination, and I gave him the answer with regard to advice. The
hon. Gentleman knows that it is not normal for Governments to publish
legal advice, and we are not about to start now. I went on to say that,
notwithstanding the advice, there are ethical issues, beyond what is in
the Bill, that need further consideration, and there is a difference
between what we are currently providing for and what would be provided
for in these circumstances. What we have is a stand-off. The hon.
Gentleman simply does not agree with me. It seems to me that there is a
difference between a power dealing with mitochondrial donation to avoid
the transmission of serious diseases and with the repairing of existing
embryos—which is where the regulation-making power is—and
a different power dealing with artificial gametes and the creation of
gametes and new life. There is a fine
distinction. On behalf
of the Government, I am saying not that we have set our face against
this, but that further discussion and further consideration of the
issues is needed. I hear what the hon. Gentleman says, but not
everybody agrees about how far away the science is from possible use.
The appropriate way forward would be proper consultation on these
issues and, if necessary, amendments to primary legislation. That is a
far more significant and important place to have these sorts of
discussions. I hear what the hon. Gentleman is saying and I understand
that he disagrees with me, but no matter how many times he puts this
proposition to me, that will be my reply on behalf of the Government.
There is a question
of understanding the very fine differences between what science might
be able to do in the future and how we seek to regulate it, and that
goes to the very heart of what we are trying to deal with in discussing
this Bill and its predecessor. Discrimination is a subset of that, but
the ethical issues must come first. I am sorry if the hon. Gentleman
does not agree
because there is a lot about which we have agreed. However, in response
to his raising such important issues in a clause stand part debate, I
have laid out the reasons for the Government’s view and if the
House takes a different view, that is a matter for the House. We remain
wedded to our
view. Question put
and agreed
to. Clause 3
ordered to stand part of the
Bill. Clause 5
ordered to stand part of the
Bill.
Schedule
1Amendments
to Schedule 1 to the 1990 Act relating to membership of the
Authority Mark
Simmonds (Boston and Skegness) (Con): I beg to move
amendment No. 22, in schedule 1, page 54, line 4, at end
insert— ‘(za) at end of
sub-paragraph (2)
insert— “and no
person may be appointed for more than six years in
total”.’. May
I take amendment No. 23 with amendment No.
22?
The
Chairman: Order. I have no strong aversion to that, but we
separated the amendments deliberately because they do not cover the
same issues. The hon. Gentleman will have the opportunity to debate
both amendments, but preferably one at a
time.
Mark
Simmonds: Thank you for your guidance, Mr.
Gale. The purpose of amendment No. 22 is to get across to both the
Government and the Human Fertilisation and Embryology Authority that,
while the HFEA is held in very high regard and is perceived globally as
the lead regulator in such issues, there is concern that it has in the
past and perhaps will in the future be a closed shop. The amendment
would ensure that amenable clinicians who wished to serve on the HFEA
and others who wanted to be reappointed could not be reappointed again
and again, as can happen at the moment. The effect of that practice is
keeping others out as the ratio of expert members is
limited. The majority
of clinics have a good relationship with the HFEA, but that is not
universal, as I have found out in my meetings with those who have had
dealings with the HFEA. Some clinics have had difficulties and they put
that down primarily—not solely—to the static membership
of the authority. There have also been issues of competitive conflict,
and it is important that clinicians do not sit on licensing committees
when determining policy that might have a beneficial impact on their
own clinics. I shall not give specific examples of that, but I am sure
that officials are aware that that has
happened. Under the
amendment, members of the HFEA could not stand for more than two
consecutive terms.
Dr.
Harris: Does the hon. Gentleman have similar concerns
about clinicians who are rivals to other clinicians being involved in
inspections, and delivering a report that might impact on the business
of those
other people? I do not know whether it is possible to avoid that
situation, but perhaps it also needs to be
considered.
Mark
Simmonds: The hon. Gentleman is absolutely right. The
purpose of a future amendment is not only to ensure that such a
situation does not arise, but to prevent clinicians without specialist
and expert knowledge in certain subjects producing reports that often
have to be corrected or reworked later. I shall deal with that when we
come to the subsequent
amendment. It would
also be helpful if the HFEA made public the dates of appointments so
that people could see how long someone had been a member of the
authority. The public should also be given assurances about the
HFEA’s fresh expertise and vigour. It is clear from my
discussions that if the Bill passes—as most of us on this
Committee hope it will, as a result of the substantial discussions in
pre-legislative scrutiny and both Houses of Parliament—the HFEA
will have an even busier time, as we gradually extend the type of
activities that it can license. It is therefore important that it does
not atrophy—although I am not suggesting that it has—but
continues to move forward with vigour, bringing in new blood as often
as possible. That is the purpose of amendment No.
22.
Dawn
Primarolo: Members of the HFEA are
appointed by the Appointments Commission on behalf of the Secretary of
State for Health following advertisements in the national press. Anyone
is free to apply and can be considered for membership. The Human
Fertilisation and Embryology Act 1990 provides
that: “A person
shall not be appointed as a member of the Authority for more than three
years at a
time”. However, that can
be extended for another three years with the agreement of the
Appointments Commission. After six years, if members wish to continue
to sit on the authority, it is not prohibited, but they must reapply
through an open competition. They may be reappointed, but only if they
are the best candidate for the
job. The
hon. Gentleman’s amendment would set a six-year limit on the
full period that any member can serve. Although it does not necessarily
sound unreasonable, it would mean a lack of flexibility to reappoint
people with valuable expertise and experience in their field. It is
essential that the HFEA comprises the best calibre of candidates
available. The amendment could restrict that.
While the hon. Gentleman was
speaking, I was looking at some of my notes in relation to his point
about the dates when people were appointed and how long their term ran
for. I do not have that information. I think that some members of the
HFEA have served for more than six years, but they started before the
process was run by the Appointments Commission. I understand that three
members have served for six years. They would have to apply for
reappointment under the current recruitment
exercise. Mike
Penning (Hemel Hempstead) (Con): Will the Minister clarify
whether that is retrospective? If they have already served six years
when the legislation comes into force, will they then have another
three plus three before they have to apply, or will the previous years
be taken into account, meaning that they will have to apply straight
away?
Dawn
Primarolo: I think that I am correct in
saying that, once the Appointments Commission became responsible, the
period considered included whatever period they might already have
served. If the hon. Gentleman will forgive me, I will need to
double-check that, but the point is that it is common on many public
bodies to have a period in which people can be reappointed before going
through a complete re-application. As I said to the hon. Member for
Boston and Skegness, an open competition is advertised and run by the
Appointments Commission, which is specifically charged with ensuring
that the public body—in this case HFEA—is staffed by
people with appropriate skills. It will also look to ensure that
anybody who applies meets the specification. Although this is published
nationally, that would still happen. I am not aware whether appointment
periods are in the public domain or whether they were on the HFEA
website. I do not have that information to hand, but I am happy to
check.
4.30
pm What
the hon. Gentleman is trying to achieve in terms of the make up of the
HFEA is already in place with respect to the break at six years and the
need to reapply. I am sure that he would agree that the converse is
true, and that even if someone has served six years, if they clearly
have the expertise and are the best person despite advertising,
national recruitment and consideration, we would not want to refuse
them access to being appointed by the Appointments Commission. I hope
that he is reassured that he can track how long members have
served—I will check that that is the case—and that there
is, in effect, a six-year break, with the caveat that people can
reapply. I am sure that he would agree with that, and I hope that he is
satisfied.
Mark
Simmonds: I am grateful to the Minister
for that response. Of course, I understand and agree with the
flexibility argument that she put forward. Obviously, we must have
people of the best calibre on the authority. However, she will also be
aware that there are a limited number of clinician places on the
authority. I am not going to press the amendment to a Division, but I
wanted to ensure that the Minister, the Committee and those responsible
for the HFEA understood the concern that a position on the authority
should not be a permanent fixture that is renewable every three years.
Certainly, publicly detailing appointment dates and the length of time
that those on the authority have served would go some way towards
satisfying people, and it would show that there was change and
turnover. I beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Mark
Simmonds: I beg to move amendment No. 23, in
schedule 1, page 54, line 17, at
end add— ‘4 In sub-paragraph 8(2),
after “experience”, insert “in at least one of the
activities that may be licensed under this
Act”. The
amendment would add a provision to schedule 1, which amends the
1990 Act. To return to the point made by the hon. Member for Oxford,
West and Abingdon, it would ensure that HFEA inspectors were doctors,
embryologists or researchers who were qualified to conduct inspection
at IVF research units. That is not necessarily what happens at the
moment, and there have been conflicts between clinics and the
HFEA, some of which have been successfully challenged
through negotiations and, ultimately, the threat of legal
action. The
inspection reports take place during the licensed period—either
three or five years—or at the end of those licensed periods for
renewal for IVF clinics. They are undertaken to inform the authority
about whether a licence should be renewed or whether there are issues
as the licensed period progresses. Those are, of course, made public
and are accessible to those who use the clinics. There have been some
issues when the interim report that the inspectors put together has
been completely disagreed with by the clinic. There is a great
nervousness among those who run some—although not all—of
the clinics that part of the reason for that is that those doing the
inspections do not necessarily have the expertise that they require and
there is a lack of understanding. There are numerous examples of having
to rework the reports.
I understand the positive move
that clinics now have the ability to make official responses to those
inspectorate reports, which are also made public. However, the starting
point must be that those doing the inspections in the first place have
a detailed understanding and knowledge of what they are inspecting.
Picking up the point made by the hon. Member for Oxford, West and
Abingdon, we must also ensure that we do not get into a situation in
which someone who is doing an inspection has a conflict of interest, or
an interest in producing a relatively negative report on a particular
clinic that might may have an advantageous effect on the clinic that
they work for.
Dr.
Harris: I am grateful to the hon. Member for Boston and
Skegness for raising this matter. Although I encouraged him to make his
point, there is a difficulty for the HFEA in finding someone with
clinical expertise who is not in competition with someone else, unless
it has a cadre of professional inspectors, which might be possible, or
one has a way of identifying people who clearly are not in competition.
For example, we would have to consider the situation for people working
in London.
Mark
Simmonds: The hon. Gentleman is absolutely right to make
that point. I am not going to raise specific examples, but I am sure
that he will be aware of one particular example in the HFEA when this
very situation arose because of the very close proximity in
geographical terms of the two clinics. That is the sort of issue that
needs to be
avoided.
Dr.
Harris: Absolutely. The hon. Gentleman’s analysis
is spot on. I would say that more creative thinking needs to be done by
the HFEA to ensure not only that conflicts of interest do not arise,
but that suspicions of conflicts of interest do not arise. This is
unfortunately—or, some would say, fortunately—a very
competitive field in which large amounts of income are at stake. I know
that the HFEA and indeed the Government are aware of the situation,
which is why they strive to ensure that there are basic standards so
that people are not misinformed about what success rates are, for
example.
Dawn
Primarolo: The hon. Members for Boston and Skegness and
for Oxford, West and Abingdon have raised an important point, and the
hon. Member for Oxford, West and Abingdon went on to elaborate why the
balance is difficult to strike. Perhaps it would be helpful if I gave
the hon. Gentlemen some indication of how the HFEA is
proceeding. At
present, the HFEA has nine inspectors. Three are embryologists, three
are nurses, one is a doctor, one is a scientist and one is a generalist
with an audit background. The HFEA has in-house inspectors and no
longer uses inspectors from outside the
HFEA. The amendment
would require inspectors to have experience in at least one of the
activities that may be licensed under the Act. That would mean that the
HFEA would be able to recruit only people who were, for example,
doctors or nurses with experience in infertility, embryologists,
scientists with experience of using human embryos in research, and
people who perhaps run internet sperm delivery services—I think
that the hon. Member for Oxford, West and Abingdon was touching on that
point.
The qualities
that make a good inspector are not necessarily limited to experience in
licensable activities, although that may be helpful. The ability to
gather evidence to ensure that centres are conducting licensable
activities in adherence with the Act, the licence conditions, and the
code of practice are vital. Therefore, people with experience of
auditing or investigating, or scientists, nurses, and doctors with
other specialist knowledge, could make equally good inspectors as those
who work in the
field. I do recognise,
and of course it is obvious, that an understanding of the licensable
activities is essential for an HFEA inspector. The authority has thus
introduced a competency-based training programme for all new inspectors
to achieve that. Part of the programme includes spending time in a
licensed centre to observe practice and to gain an understanding of how
a centre works from day to day. The HFEA also has a number of external
advisors who have experience in activities that may be licensed under
the Act, such as nurses, doctors and embryologists who act as
inspectors on a number of inspections every
year. I
think that the concerns of the hon. Member for Boston and Skegness are
being addressed by ensuring that the inspectors are suitably qualified
and able to report with regard to the code and the licence
conditions. He and the hon. Member for Oxford, West and Abingdon flag
up a live issue to the HFEA concerning a reasonably small community of
practitioners, the importance of having such expertise, and the need
not to undermine the commercial or business concerns that often
underpin these
clinics. I
hope that the hon. Member for Boston and Skegness will accept that the
amendment is not necessary, that it would be over-restrictive, and that
there might be problems with recruiting the qualified people he feels
might be necessary. Nonetheless, the HFEA is addressing this matter,
and what is important is that the inspectors can consider the issues
before them. I hope, on that basis, that he will be prepared to
withdraw his amendment.
I am not sure how this might be
achieved, but if the hon. Gentleman is particularly interested in the
specific work that the HFEA is doing with regard to its
in-house inspectors and their qualifications and how to avoid any of the
problems that he feels might exist, I am sure that we could find a way
of ensuring that he is kept in touch with developments so that he can
satisfy himself and his colleagues on those
issues. | 
