The
Chairman: Order. I think that the hon. Gentleman is going
a wee bit away from the amendment. Again, the issue could be raised in
the clause stand part debate, not on this group of
amendments.
Robert
Key: I obviously have to accept your ruling,
Mr. Hood, but I am talking very specifically to amendment
No. 156. May I please
proceed?
The
Chairman: Order. I tell the hon. Gentleman that clause 6
is not being amended, but he is speaking to it as if it
is.
Robert
Key: Mr. Hood, I am talking about amendment No.
156 to clause 27, which was moved by my hon. Friend the Member for
Boston and Skegness.
The
Chairman: Order. My guidance to the hon. Gentleman is to
look to the clause stand part debate and to speak specifically to the
amendment. That is in line with my earlier advice to the hon. Member
for Boston and Skegness.
Robert
Key: Of course, I accept your ruling, Mr. Hood.
If I may, I will speak to clause 27, page 31, line 26—to
amendment No. 156.
On the fees
that are charged for cycles, NHS trusts will not pay for frozen cycles,
and I wonder who made that ruling. An application for a separate
licence must be made for each and every cycle, and that must be granted
by the HFEA. The authority charges £104.50 per licence. That
means that the Salisbury fertility clinic, which treats about 200
patients a year with fresh or frozen cycles, pays about £200,000
a year in fees. There are more than 100 IVF clinics in the UK, so our
constituents pay about £2 million a
year.
Mark
Simmonds: It might help my hon. Friend if I give him the
exact figures. In the 2006-07 financial year, HFEA income was
£6.7 million, of which grant aid—I assume that it came
from the Department of Health—was £1.95 million. That
means that the authority got £4.8 million in fee
income from our constituents.
Robert
Key: That is absolutely right. The IVF cycles paid for by
our constituents represent a significant proportion of that
income.
The
proportion of private and NHS patients being charged is about half and
half. In half the cases, therefore, the HFEA fee is paid by the
patients, while in the other half, it is paid by the primary care
trusts. However, the primary care trusts are simply transferring money
from one part of the NHS to the other, with all the concomitant
bureaucracy involved in the procedure. That, in itself, must cost a
substantial
amount. There
is another unfairness for our constituents in the charging structure.
If, in an IVF cycle, there were some spare gametes for a patient, some
of them would routinely be frozen in case they were needed in the event
of failure. If the fresh cycle fails, believe it or not a new licence
costing another £104.50 has to be applied for and
granted—for the same gametes. The patient is therefore paying
twice yet the clinic incurs no extra cost, apart from the cost of the
storage of spare gametes. How can the whole bureaucracy and fee
structure be justified for what is now a routine
procedure?
Mark
Simmonds: Is my hon. Friend aware that financial
implications arise from the Bill? He has suggested that the
expectations of increased expenditure by the HFEA will be met not by
additional resources from the Department of Health, but only by
additional fees being
charged.
Robert
Key: I detect the dead hand of the Treasury intruding once
again into the personal lives of our constituents. I entirely support
my hon. Friend’s amendment. On behalf of our constituents, it
should be Parliament, not the Treasury, that decides whether the
charging regime is
justified.
Dawn
Primarolo: I wish to explain what actually happens and
why, rather than there being a dastardly plot set up by the
Treasury.
Hon.
Members: It is quite
possible!
Dawn
Primarolo: It is a little strange that Conservative
Members wanted the regulation that was accepted when the 1990
legislation went through under their Government, whereby there should
be a fee structure to recoup the costs of the regulation, yet they now
consider that that principle should be broken in respect of what the
fees are charged for and how they are arrived
at. Amendment
No. 156 would provide for the fees to be set out in regulations to be
approved by both Houses. The HFEA undertakes consultation on its fee
scheme and levels involving the public and stakeholders. That is
similar to provisions under the 1990 Act. The Bill provides that the
HFEA can set its fees in accordance with the scheme approved by the
Secretary of State and the Treasury, and I see no reason to change
that. At present, the HFEA makes a recommendation, having discussed
with stakeholders what they believe the fee levels should be. A review
is undertaken every two years, and it is not the case that fees always
increase. This
is not about the Treasury saying what will be charged, but the HFEA
asking for endorsement. That ties in with the fact that the HFEA is a
quasi-independent body. We made the important decision recommended by
the Warnock report so that matters relating to the function of the
authority, including how it carries out
its functions in respect of fees, are properly the business of the
authority to determine and justify. That was where the authority was in
1990. That was recommended in the discussions on the independence of
the HFEA in discharging its regulatory functions as determined by
Parliament, and the fees are about recouping its
costs. Robert
Key: Will the Minister give
way?
Dawn
Primarolo: I am happy to give way. I will answer in detail
the points that the hon. Gentleman has already made. I accept that he
has changed his mind since 1990, but the Government have
not.
Robert
Key: Eighteen years ago, when the Minister and I were
fresh young things on the Standing Committee that considered the 1990
Bill, the HFEA was a new institution and nobody knew how much it would
cost to run. The procedures for IVF were novel and nobody knew how they
would be taken up or what that would cost the NHS. Caution, therefore,
was entirely sensible. The point that I have already made, which the
Minister has failed to acknowledge, is that these are now routine
procedures and routine parts of NHS performance, and that we need to
change our minds. Parliament needs to change its mind. We no longer
insist on people walking in front of cars with red flags, and we should
not insist on this charging
regime.
The
Chairman: Order. That was a rather long
intervention.
Dawn
Primarolo: I understand the hon. Gentleman’s point.
We continue to regulate the system. Some argue that there should be no
regulation on IVF because it is so mainstream. They say that we should
not have the regulation that is provided in the Bill and that the
matter should be removed entirely from the auspices of the HFEA.
However, that is not the view endorsed by Parliament, nor is it the
view of the Government. The HFEA’s independence would be eroded
and undermined by the amendment, yet it has to have independence. The
other question is where we would draw the line on the HFEA’s
independence. Would we allow it to determine its own procedures for
using its regulation powers, regulating according to the wishes of
Parliament, and the costs for that? It may also be considered that
removing from the authority the responsibility for setting such
procedures will work against better regulation. We need to ensure that
the authority has an incentive to reduce the regulatory burden and
improve its procedures, that it regulates according to the wishes of
Parliament and that it does so in dialogue with its stakeholders, and
takes into consideration what they think. The first implication of
amendment No. 156 is that it should not be the function of the HFEA to
set its own fees. That is something with which the Government and I do
not agree. It is appropriate that the HFEA seeks to recoup the cost of
regulating
clinics. Other
costs that the HFEA might incur, such as legal fees, are met by the
Department as part of the HFEA’s grant. Members of this
Committee and of the House expect the Government to be concerned to
ensure that the HFEA is fulfilling its functions in an efficient and
cost-effective way. That would always be part of the discussions about
the rest of the running, not the regulation of the licences. I hear what
the hon. Member for Salisbury says about the level of fees, but I think
that that is a separate issue. It is entirely appropriate that the HFEA
intends to review its fee structure as part of the major project to
consider how it operates and how it is undertaking its role. It must
take into consideration the implications of the Bill, when it is
approved by Parliament, and reflect on the points made by the hon.
Member for Salisbury—whether it is timely to revisit when fees
are applied, at what level and for what
purpose. 12.15
pm I
remind the Committee that the fees are paid by clinics and research
centres towards the HFEA’s operating costs, including the
continuing work to improve and strengthen regulation. The fees cover,
for example, the cost of licensing and inspecting clinics to ensure
that they are complying with the HFEA code. The authority reviews its
fees annually and makes a recommendation to the Secretary of State, who
agrees them. They are approved by the Treasury as well. As I said, they
are not increased every
year. The
current fees were referred to by the hon. Member for Salisbury, so I do
not need to touch on them. The fees paid for costs depend on the type
of treatment carried out or the complexity of the research, but, as I
said, the HFEA is reviewing its fee structure. It is important that
there is transparency on the level of the fees, why they are set at
those levels, the costs that they are intended to cover, and that
everyone understands that clearly. I do not accept that amendment No.
156 would improve how fees are set or take us any further forward. In
fact, it would be in danger of questioning the independence of the
HFEA. Amendment
No. 157 relates to the authority’s ability to charge a fee to
people making an application for information from the register or for
providing the information. Clause 27 is intended to enable the HFEA
only to cover the costs of doing so and, as I have said repeatedly when
the question of HFEA fees has been raised in Committee, it is not about
income generation. The effect of amendment No. 157 would be that the
authority “must”, rather than “may”, have
regard to the costs incurred by it when dealing with an application or
the provision of information about genetic parentage. On a
straightforward technical point, the use of “may” is
common in legal drafting and is appropriate in cases in which there is
no obligation. That is clearly the point that we are trying to get
across. The HFEA does not necessarily have to charge a fee for requests
for such information as are proposed, and therefore “may”
is entirely appropriate in such
circumstances. While
I understand the points made by the hon. Members for Boston and
Skegness and for Salisbury, and the force with they are making them, I
hope that they agree that a more sensible way to proceed would be to
allow the HFEA to continue to be accountable, to review its fees, to be
in discussion with its stakeholders and then to make recommendations to
the Secretary of State and the Treasury for approval, once those
increases, decreases or no increase are decided. If the authority does
that annually, it is entirely appropriate for that to
continue. If the hon. Member for Boston and Skegness feels that he needs
to press his amendment to a Division on that principle, I will ask my
hon. Friends to resist
it. Dr.
Harris: Since there may well be a vote on the amendment, I
ought to say one or two paragraphs on it. The Minister is absolutely
right that if we believe that IVF has to be regulated, there must be
fees to pay for it—that is if we agree that the regulator should
be funded at least partly by the people whom it regulates, which is a
common model.
I have long
argued a point that I think the Select Committee report of 2005 made:
now that we are 15 years on from the halcyon days of the fresh youth
described by the hon. Member for Salisbury—perhaps others might
argue that he and the Minister are still both fresh young
things—IVF is just as routine, after the initial concerns about
safety, as some unlicensed treatments involving drugs and surgery.
Although there is an ongoing requirement of registration for the
purposes of donor information and so on, I hope that it will be
accepted that there is an argument for deregulation. That does not mean
that there does not need to be quality assurance by the Healthcare
Commission, involvement by the General Medical Council, or even close
scrutiny of claimed success rates, because IVF is relevant to a
particularly desperate population. However, should that mean licensing
every routine IVF cycle? No, although I would still argue that some of
the newer approaches should be licensed and that there should be no
diminution of the regulation of
research.
Dawn
Primarolo: The hon. Gentleman is making a respectable case
for having no regulation. I do not happen to agree with him, but surely
the hon. Members for Boston and Skegness and for Salisbury need to
address the point that the principle of regulation is that its costs
are recouped from those who are regulated. That has been an absolute
principle of all the relevant legislation since 1990. Not liking the
fees is one thing, but a case has not been made for why we should
deviate from the principle of
regulation.
Dr.
Harris: I made that point at the beginning. If we believe
that IVF should be regulated, we must have a way of paying for it. I am
making the point that it should be deregulated. However, given that
there is regulation, and that the Select Committee did not win the
argument on that point, the Government’s structure is a
reasonable approach. That is the only reason why I do not plan to
support the amendment. A better approach would be to deregulate.
Although there will, of course, be sensitive issues and a need for
special provisions when we discuss the next Bill, I hope that this
medical treatment, which is now routine and, as far as we know,
safe—no less safe than many other medical treatments—will
be
deregulated.
Mark
Simmonds: I am delighted that the amendments have
stimulated such a detailed and comprehensive discussion. As my hon.
Friend the Member for Salisbury said, there is concern about the issue
and the possibility of fees being charged that will impinge on all our
constituents.
The point of
amendment No. 156 is not to remove the independence of the HFEA but to
ensure that there is sufficient scrutiny by those who represent
constituents, on whom the level of fees will have an impact. The
Minister is not correct to say—I may have misheard
her—that all HFEA income is recouped through recharging. It is
not. There is a grant aid system, which pays some of the cost. There is
no doubt that the Bill has the potential to increase the HFEA’s
level of activity and its size. My understanding is that there is no
proposal to increase the grant aid from the Department of Health, so
the additional income will come from the charging of additional
fees. Of
course, I acknowledge that while the Minister is in situ, she will
consult the Secretary of State and the Treasury and will not allow the
fees to be a revenue-generating exercise, but that may not always be
the case. If I were a Minister rather than a shadow Minister, I would
ensure that they only covered the costs rather than raised revenue. We
must ensure that that happens as part of the Bill, because the 1990
Act, which we are amending, has been in place for 18 years, and we hope
that this Bill will be as well. I do not think that the HFEA would have
a rigorous and detailed charging regime imposed on it by Parliament,
but is right that the HFEA should come to Parliament to justify its
fees and the impact that they would
have. If
I withdrew the amendment, it would be with some reluctance, so I am not
going to do so.
Question
put, That the amendment be
made:— The
Committee divided: Ayes 5, Noes
11.
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